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Full text of "General therapeutics and materia medica (volume 1): adapted for a medical text book"

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THE 

ABNER WELLBORN CALHOUN 

MEDICAL LIBRARY 

1923 




Class. 



Book 



PRESENTED BY 






GENERAL 



THERAPEUTICS 



AND 



MATERIA M E D I C A 



ADAPTED FOR A 



MEDICAL TEXT BOOK. 



By ROBLEY DUNGLISON, M. D., 

PROFESSOR OF INSTITUTES OF MEDICINE, ETC., IN JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA; 

FORMERLY PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN THE UNIVERSITIES 

OF VIRGINIA AND MARYLAND, AND IN JEFFERSON MEDICAL COLLEGE 

OF PHILADELPHIA. 



ONE HUNDRED AND EIGHTY-TWO ILLUSTRATIONS. 
FOURTH EDITION, REVISED AND IMPROVED. 

IN TWO VOLUMES. 

VOL. II. 




PHILADELPHIA: 
LEA AND BLANCHARD 
1850. 



Entered, according to Act of Congress, in the year one thousand eight 

hundred and forty-two, by 

ROBLEY DUNGLISON, M.D., 

in the Clerk's Office of the District Court for the Eastern District of Pennsylvania. 



G-, f + 

r , 



KING & BAIRD, PRINTERS, SANSOM STREET, PHILADELPHIA. 



CONTENTS OF VOL. II. 



CHAPTER III. 

OF MEDICINES. 

SECTION VI. 

AGENTS THAT AFFECT VARIOUS ORGANS. 

PAGE 

II. Topics. — Tonics differ from excitants — The former defined — Modus operandi — 
Tone, and want of tone, on what dependent — Tonics, direct and indirect — Bitter 
extractive the great tonic principle of vegetables — Tonics given with two great 
views, to strengthen the system and to break in upon a morbid catenation — Thera- 
peutical application of tonics — In febrile diseases — In inflammatory disorders — In 
the neuroses — Mental tonics — Special tonics . . . . .17 

Therapeutical application of tonics ..... 23 

Special tonics . . • • • • • . .33 

J . Simple tonics ........ 34 

a. Bitter tonics that owe their tonic virtues to bitter principle singly . 34 

b. Aromatic bitter tonics, that possess, along with bitter principle, more or 

less aromatic property ...... 44 

c. Astringent bitter tonics, which have an astringent associated with the 

bitter principle . . . . . • .51 

d. Mechanical tonics, or such as seem to act mechanically . . 53 

e. Mineral tonics ....... 54 

2. Antiperiodic tonics . . • . . . .73 

III. Astriwgettts. — Definition of astringents — Tannic acid, the great vegetable 
astringent principle — Their modus operandi — Act best on parts with which they 
come in contact — Bad effects of astringents — Indirect astringents— Therapeutical 
application — In fevers, inflammations, hemorrhages, &c. — Astringents often used 

by the surgeon — Styptics — Special astringents . . . . .94 

Therapeutical application of astringents . . . . .100 

Special astringents . . . • • . • .117 

1. Vegetable astringents . . . . . .117 

2. Mineral astringents . . . • • • .137 

IV. Sedatives — General observations — Subdivision of sedatives — Definition of seda- 
tives — Modus operandi — Thomson's table of sedatives — Mental sedatives — Blood- 
letting — Its effects — Cautions respecting its use — Arteriotomy, phlebotomy, local 
bleeding — Other sedatives — Contra-stimulants — Special sedatives . . 150 
Special sedatives . . . • . • • .181 



VI CONTENTS. 

PAGE. 

V. Refhigerants. — Definition of refrigerants — Modus operandi — External and in- 
ternal refrigerants — Refrigerant baths — Therapeutical application of refrigerants — 

In fevers — In the phlegmasia?, &c. — Special refrigerants . 2 °2 

Therapeutical application of refrigerants . 207 

Special refrigerants . . . . . . . .211 

1. Saline refrigerants . . . . . . .211 

2. Topical refrigerants . . . . . • .214 

VI. REVEi.rF.NTS. — Definition of revellents — Epispastics — Definition of epispastics 
— Rubefacients — Vesicants — Suppurants — Actual and potential cauterants — Mo- 
dus operandi — Permanent and intermittent revulsion — Intensity of the revulsion — 
Blisters, as revellents in fever — Revulsion in the changeable phlegmasia? — Choice 
of situation for the revulsion — Therapeutical application of revellents — In fevers — 
— In the phlegmasia? — In hemorrhage — In mental alienation, hysteria, tetanus, &c. 
Special revellents . . . . . . . .217 

Therapeutical application of revellents ..... 232 

Special revellents . ....... 247 

a. Rubefacient revellents ...... 247 

b. Vesicant revellents ....... 256 

c. Suppurant revellents . . . . . .261 

d. Escharotic revellents ....... 266 

1. Erodents ....... 266 

2. Actual cauterants ....... 268 

3. Potential cauterants ...... 270 



VII. EtjTnopHics. — Eutrophics defined — Alteratives — Modify the function of nutri- 
tion — Sorbefacients — Therapeutical application of eutrophics — Pressure — Friction 
— Special eutrophics ........ 276 

Therapeutical application of eutrophics ..... 282 

Special eutrophics ........ 286 

Topical eutrophics ........ 344 

1. Eutrophic ointments ....... 344 

2. Compressing eutrophics ••.•... 346 

3. Eutrophic liniments ....... 347 



SECTION VII. 

AGENTS WHOSE ACTION IS PROMINENTLY CHEMICAL. 

I. Antacids. — Definition of antacids — Great generation of acid in dyspepsia — Acids 
always in the healthy stomach — Morbid acidity, how induced — Predominance of 
acidity in children — Antacids only palliatives — Special antacids . . .351 
Special antacids ••...... 356 

II. Antalkalies. — Definition of antalkalies — Cannot often be needed — Alkaline state 

of the habit — Mode of improving defective nutrition — Special antalkalies . . 360 

Special antalkalies ....... 362 

III. Disinfectants. — Definition of disinfectants — Antiseptics — Modus operandi of 
disinfectants — Bad effects of odorous fumigations — Of heat, mineral acid vapours 

and the chlorides as disenfectants — Use of antiseptics — Special disinfectants . 362 

Special disinfectants ••••... 367 

a. Disinfectants of apartments, clothing, &c. .... 367 

b. Disinfectants of the living body — Antispetics . . . -371 



CONTENTS. Vll 

SECTION VIII. 

AGENTS WHOSE ACTION IS PROMINENTLY MECHANICAL. 

PAGE. 
Modus operandi of mechanical agents — May affect the vital operations — The least 
important of our therapeutical resources ..... . 375 

I. Demulcents. — Definition of demulcents — Of emollients — Not remedies of any 
activity — Therapeutical application — Are digested in the stomach — Therapeutical 

use of emollients — Special demulcents ...... 375 

Special demulcents ........ 380 

a. Internal demulcents . . . . . . . 380 

b. External demulcents — Emollients ..... 393 

II. Dtetjents. — Necessity for drinks — Therapeutical use — Their absorption pre- 
vented by certain circumstances — Employment in dropsies, diseases of the urinary 
organs, &c. ......... 397 

SECTION IX. 

OF DEOBSTRUENTS, ANTIDOTES AND ANTIPARASITICS. 

Deobstruents — Are indirect agents. Alteratives — Their modus operandi — Only used 

in chronic diseases. Antidotes — Definition of — Are of two kinds Division of 

poisonous agents — Therapeutics of poisoning, internal and external — Table of 
poisons and their antidotes — Antiparasitics . . . . .401 

I. Deobstruents . . . . . . . .401 

II. Antidotes •••...... 420 

Table of poisons and their antidotes . . . . . 440 

III. Antiparasitics . . . . . . . .413 

Special antiparasitics . . . . . . . 413 

SECTION X. 

MINERAL WATERS. 

Table of some of the principal mineral waters . .415 

SECTION XL 

ON THE COMBINATION OF THERAPEUTICAL AGENTS. 

Importance of a due attention to principles — Value of authority — Professional qnalifi 
cations may be estimated by the prescription — Evils of complexity in prescribing- 
Rules for prescribing — Table of incompatibles — Doses of medicines — Conclusion . 427 
Tables of chemical incompatibles ..... 437 

Index of diseases and remedies ...... 445 

Index of remedies ...... 467 



GENERAL THERAPEUTICS 



MATERIA MEDICA. 



CHAPTER III. 

OF MEDICINES. 



SECTION VI. 

AGENTS THAT AFFECT VARIOUS ORGANS. 



II. TON'ICS. 

Sison. Confortantia, Corroborantia, Conjirmantia, Roborantia. 

Tonics differ from excitants — The former defined — Modus operandi — Tone, and want of 
tone, on what dependent — Tonics, direct and indirect — Bitter extractive the great tonic 
principle of vegetables' — Tonics given with two great views, to strengthen the system and 
to break in upon morbid catenations — Therapeutical application of tonics — In febrile 
diseases — In inflammatory disorders — In the neuroses — Mental tonics — Special tonics. 

The excitants, considered in the last division, are diffusible in their 
action, and transient in their effects — the stimulation being followed by 
a degree of depression proportionate to the extent of such stimulation. 
They excite, therefore, beyond what may be considered as the healthy 
standard. The substances, which are now to be investigated, as a 
general rule operate silently and permanently. They are followed by 
no undue depression, when discontinued; and they may be employed 
in states of the system in which the use of Excitants proper might be 
questionable. Accordingly, when the practitioner is in doubt, whether 
the case before him will admit of stimulation ; and the weight of evi- 
dence urges him to that course, he usually prefers commencing with a 
slightly stimulating tonic — to beginning at once with the diffusible exci- 

Vol. II.— 2 



18 TONICS. 

tants ; knowing that the former may be discontinued without detriment, 

whilst the latter can only be cautiously pretermitted, especially if their 
employment has been persevered in for some time. 

Tonics are usually defined to be :— Agents, which give strength and 
vigour to the body. In this point of view, all strengthening aliments 
might fall under the division. These are, in reality, tonics ; but, as 
before observed, the consideration of aliments is not comprised in the 
objects of this work. It has been attended to elsewhere, {Human 
Health, p. 179). . 

By many therapeutical writers, tonics have been conceived to act by 
improving the tonicity of the muscular system ; and, in the classification 
of Dr. A. T. Thomson, they are separated from excitants proper, and 
classed with astringents, under the head of— " Vital agents, influencing 
the body generally by operating directly on the muscular and sanguife- 
rous systems." Yet, he subsequently affirms, that tonics "act on the 
vital principle through the medium of the nerves, and as far as their 
mode of operating is understood, we may regard them as excitants." 

To elucidate his idea on the modus operandi of tonics, he has the fol- 
lowing observations: — "When an individual is in good health and in 
vigour of body, the muscles or moving organs feel firm and tense ; they 
act regularly and powerfully, whether they are involuntary muscles, or 
those under the control of the will. This is a state of healthful tone. 
On the contrary, when the muscles feel soft and flabby, when the action 
of the involuntary muscles is languid, and the voluntary do not rapidly 
respond to the will ; when there is a strong inclination for rest and 
indulgence ; and when the movements of the body or its parts are per- 
formed with difficulty, this is a state of deficient tone or debility. That 
both these states are connected with the condition of the muscular fibre 
may be demonstrated by detaching a muscle from the bodies of two 
animals in these opposite conditions, and ascertaining its strength by 
appending weights to it: the muscle taken from the healthy animal, or 
that in a state of tone, will sustain a much greater weight than that which 
is in the opposite state. Thence, to a certain extent, tone implies a dif- 
ference in the mechanical condition of muscles; a greater degree of 
density and cohesion of their component fibres ; but this must be also 
joined with elasticity, that is, the power of resisting extension, and of 
restoring itself when the extending cause is removed, before the part 
can be said to be in the state of perfect tone. That this state is truly 
the result of vital energy is evident ; for the same muscle loses the 
power of sustaining the weight, which it supported when first cut from 
the body, and this in proportion to the distance of time from that of its 
separation from the living body," — and he adds : " medicines or medi- 
cal agents, which produce this state of healthful tone, and renew the 
tension and vigour of the muscular fibre, are thence denominated tonics." 

Sir Gilbert Blane also asserts, that no muscle, whether voluntary or 
involuntary, can act unless its fibres are previously in such a state, that 
if divided they would shrink by their own resiliency, leaving an inter- 
val between the cut extremities ; and Dr. Paris — after citing the above 
remark of Sir Gilbert— observes : — " It appears, that there are certain 
medicinal bodies, that have the power of effecting this state of tension 



MODUS OPERANDI. 19 

and when their effects contribute to its restoration, they are properly de- 
nominated tonics." Yet this resiliency, described by Sir Gilbert, is not 
necessarily even a vital minifestation. It may be independent of the 
vital properties. It continues for some time after the total extinction of 
life in all its functions : appears to be connected simply with the physi- 
cal arrangement of the molecules ; and is not affected until the progress 
of decomposition has become sensible. Hence, it has been properly 
regarded, by Haller and others, as a vis mortua. 

Flexibility, extensibility, and elasticity are variously modified, and 
combined in the different forms of animal matter ; and they exist to a 
greater or less extent in every organ. Elasticity is only exerted under 
special circumstances. The tissues, in which it is inherent, are so dis- 
posed through the body as to be kept in a state of extension by the 
mechanical circumstances of situation, but, as soon as these circum- 
stances are modified, elasticity comes into play, and produces shrinking 
of the substance. The gaping wound, produced by a cut across a 
cooked shoulder of mutton, is an example, familiar to all, of this elas- 
ticity or resiliency. Previous to the division, the force of elasticity was 
kept neutralized by the mechanical circumstances of situation, or by 
the continuity of the parts ; but, as soon as this continuity was disturbed, 
or, in other words, as soon as the mechanical circumstances w r ere 
altered, the force of elasticity was exerted, and produced recession of 
the edges. This property of elasticity has been called contra ctilite de 
tissu, and also tone or tonicity ; — names which have probably suggested 
the modus operandi assigned to tonics, which we have been discussing. 

That diminished cohesion, like that adverted to, may occur as the re- 
sult of disease is doubtless. Pathology affords us numerous examples 
of it, although not so many as is usually supposed ; and it is by no means 
easy to see, that such a pathological condition must always exist, when 
tonics are indicated, or whenever they prove beneficial. The only way, 
it w r ould seem, that these agents can act on the muscles, is on their 
contractility, like excitants; and indirectly on their nutrition, through 
the medium of the nerves distributed to the stomach ; — the irradiations 
being conveyed from thence to every part of the nervous system ; 
and therefore to every portion of the frame endowed with nervous 
influence. 

Want of tone appears to depend, in the majority of cases, certainly, 
— on exhaustion of muscular contractility, and on impaired nervous 
influx. Physiology and pathology afford us numerous examples in sup- 
port of this position ; but it will only be necessary to refer to a few. 

The cozncesthesis or common feeling of many people is so much influ- 
enced by the condition of the atmosphere, that they become almost 
barometers, — feeling light and buoyant when the air is clear and dense ; 
and gloomy, when it is moist and light. Again, if the bowels be loaded, 
the powers of the system are, at times, so depressed, that general lan- 
guor and lassitude prevail ; and the individual is incapable of the 
slightest muscular effort. In like manner, after continued exertion, 
fatigue is felt, and rest absolutely demanded, until the exhausted ex- 
citability has been recruited ; and, lastly, if a man, previously in perfect 
health, be struck with the contagion of a malignant fever, he finds his 



20 



TONICS. 



strength dissipated, and that he is incapable of raising ^^2Zl 
as he, a short time previously, could raise pounds. X " X'uscle is 
cases can we presume that the mechanical condition °t*%"™ £ 
materially changed. In the cases of the varying atmosphere, ine 
Ended bowel , fnd the impression of malignant fever, the feelings of 
debilUv must be regarded as wholly dependent on the condition of the 
nervou^yTtem; and in that of great fatigue after protracted exercise 
TSoa of the muscular contractility under the perpetual 
excitement produced by the repeated efforts of yolition.-the nervous 
influx exKu P ss the muscular contractility or excitability like any other 



How strongly want of tone is connected with the state of the nervous 
svstem is seen in the depressing influence of nostalgia or homesickness, 
f wh'ch ev ry voluntary function is carried on in languor and asthenia ; 
and on the other hand, we are equally struck with the evidences of 
strength, which the maniac exhibits. In such cases, the delicate muscles 
of the female execute feats, which the largely developed muscles of the 
athletic male, under the ordinary or healthy nervous influx would be 
incapable of accomplishing. The effects, too, of mental tonics must 
manifestly be exerted on the brain, in the first instance; and, through 
the medium of the nerves, on the rest of the body. 

Under the salutary nervous excitation, which tonics are capable ot 
effecting, the action of the capillaries over the whole system becomes 
augmented ; nutrition is increased and the vis insita elevated to the full 

healthy standard. . 

It is probable, that all tonics are obscurely stimulant ; but they diner, 
as before remarked, from excitants proper, in not stimulating to a marked 
decree, and in the excitation not being followed by corresponding de- 
pression. They exert, however, no perceptible stimulation : their 
action, though efficacious, is silent ; and, if they be repeated at proper 
intervals, a permanent, healthy state of tone results. But all this is pro- 
duced through the agency of the tonic upon the nervous system ; and 
there does not appear to be any satisfactory reason for believing, with 
Dr. Chapman, of Philadelphia, that tonics, " like every other class of 
medicines are endowed with some properties peculiar and distinctive, 
amonw the most conspicuous of which is their specific affinity to the 
muscular fibre." 

Tonics may be either direct or indirect ; — that is, they may be the 
means of adding directly to the healthy tone of the system, in the mode 
described ; or, in particular conditions of the economy, other substances 
belonging to different classes of therapeutical agents may exert a tonic 
effect indirectly. In this way, blood-letting, cathartics, emetics, &c, 
may be indirect tonics In the state of apparent debility, which ac- 
companies febrile or other irritation, and in that in which the stomach 
or intestinal canal is loaded, and the nervous system oppressed and 
depressed, a remedy, which obviates these conditions, will remove the 
debilitant effects of such conditions, and prove tonic. When, however, 
we use the term tonic abstractedly, we never apply it to those indirect 

agents. 
It has been a question, occasionally agitated by therapeutists, whether 



GENERAL EFFECTS. 21 

there be any such thing in nature as a real tonic; or, in other words, 
whether any remedial agent can, by virtue of properties inherent in it, 
communicate tone where tone is defective. It would appear, that no 
such properties are possessed by any agent ; or, in other words, that no 
principle is infused into an asthenic organ or tissue, which can give 
strength to it. The whole effect is exerted, directly or indirectly, on the 
nerves of the stomach; whence it is distributed, by means of the nerves, 
to every part of the system. It is probable, too, that some of the arti- 
cles of the class are absorbed, and act upon the organism through the 
altered character of the blood in the capillary blood-vessels. Such, it 
has been conceived, is the modus operandi of the preparations of iron in 
chlorosis and other affections. Some tonics, again, are insoluble, and 
pass, — apparently unaltered, — through the digestive tube, appearing to 
exert their influence like certain condiments, which contain no nutri- 
ment, but which place the chylopoietic organs in a condition for deriving 
a larger amount of nutriment from alimentary matters taken along with 
them than they would otherwise have been able to separate. 

When a tonic is administered in disease, its speedy operation is not 
to be expected. This is one of the essential points of difference be- 
tween tonics and excitants proper. The effects — as already remarked 
— are gradually, and almost insensibly exhibited ; and they afford as 
good specimens of the action of what have been termed ' alteratives^ 
as any that could be selected. They produce no sensible evacuation. 
Under their employment, the appetite gradually improves ; the impres- 
sibility of the nervous system — often induced by long protracted indis- 
position, or by a rapid reduction of the vital forces, as in acute diseases 
— lessens; the action of the circulatory system assumes the healthy 
standard ; the general feeling exhibits itself buoyant and elastic ; and 
the muscular powers, under the improved nervous influx, resume their 
wonted energy. But all this denotes only a restoration to the healthy 
standard ; hence, the great use of tonics in convalescence ; but if ad- 
ministered in conditions of the system in which they cannot be expected 
to do good, they are devoid of the injurious consequences, that follow 
the undue use of excitants proper, and their administration may be 
arrested at any moment without fear of debility resulting. It has been 
already seen, that it is the use of diffusible stimuli, which is alone fol- 
lowed by corresponding depression. 

Bitter extractive appears to be the great tonic principle of most 
of the vegetable tonics; aided, in some, by the presence of aromatic 
oil, which renders them more stimulating; in others, by the presence 
of one or both of the great astringent principles of vegetables. This 
bitter extractive is not affected by heat ; but the aromatic oil is, pro- 
vided the boiling temperature be maintained for some time. Decoc- 
tion is, therefore, an improper mode of preparation, where the object is 
to retain the aromatic property. Infusion is the form most commonly 
prescribed ; and hence the pharmacopoeias contain officinal infusions 
of all the principal vegetable tonics. 

Dr. Thomson asserts, that Dr. Chapman, and, following him, Dr. 
Paris, attempt to prove, that bitterness is essential to tonics ; or, in other 
words, that it is the tonic principle ; but in this, he does those writers 



22 TONICS. 

injustice. The latter gentleman affirms, that the tonics, derived from 
the vegetable kingdom, are generally bitter ;— whilst the former ex- 
pressly says :— " Concerning the element, which gives the tonic power, 
some difference of opinion has been entertained. Cullen supposed it 
to be the same quality as that of bitterness. But though it holds to a 
considerable extent, there would seem to be no necessary connexion in 
all cases. Exceptions at least are not wanting, as we see very strik- 
ingly in opium and digitalis, which are bitter, though not tonic ; and, 
conversely, in many of the metallic articles, which, though tonic, are 
not bitter in the slightest degree." Nor do we think Dr. Thomson 
more accurate in his opinion, " that part of all the vegetable tonics are 
[is] digested in the stomach, and the principle, whatever it is, which 
produces their tonic influence, is thus separated from the other parts ; 
and consequently it is enabled to act with more energy upon the nerves 
of the stomach :"— an explanation that can scarcely apply to infusions 
of vegetable substances ; and still less to the active principles of such 
substances ; nor is it more applicable to them when given in a solid 
form, as in the state of powder, in which the active principle is, in 
many cases, combined with little more than lignin or woody fibre. It 
is but necessary, that the fluids of the stomach, or any fluids, should 
come in contact with the substance in order to extract its tonic virtue ; 
but nothing like digestion— as applied to the physiological process to 
which alimentary matters are subjected — is necessary. 

Bitter extractive, as Dr. Paris has remarked, is a great natural tonic. 
It appears to pass through the body without suffering any diminution 
in its quantity, or change in its nature. No cattle will thrive upon 
grasses, that do not contain a portion of this principle ; a fact, which is 
considered to have been proved by the researches of Mr. Sinclair, gar- 
dener to the Duke of Bedford, who remarks, in his " Hortus Grami- 
neus Wobumensis" that if sheep be fed on yellow turnips, which 
contain little or no bitter principle, they instinctively seek for, and 
greedily devour, any provender, which may contain it, and if they can- 
not obtain it they become diseased, and die. " We are ourselves 
conscious," Dr. Paris adds, " of the invigorating effects of slight bitters 
upon our stomach ; and their presence in malt liquors not only tends to 
diminish the noxious effects of such potations by counteracting the 
indirect debility, which they are liable to occasion, but even to render 
them, when taken in moderation, promoters of digestion. The custom 
of infusing bitter herbs in vinous drinks is very ancient and universal: 
the poculum absinthiatum was regarded in remote ages as a wholesome 
beverage, and the wormwood was supposed to act as an antidote against 
drunkenness. The Swiss peasant cheers himself amidst the frigid 
solitude of his glaciers with a spirit distilled from gentian, the extreme 
bitterness of which is relished with a glee, that is quite unintelligible to 
a more cultivated taste." 

Tonics may be given with one or two views ; — either to make a 
decided impression on the nervous system, so as to break in upon a 
chain of morbid phenomena that supervene in paroxysms — as in inter- 
mittent fever; or to produce their silent but permanent operation for the 
removal of debility. The same form of preparation is not equally 



THERAPEUTICAL APPLICATION. 23 

adapted to the two cases. In the former, the lignin or woody matter of 
the vegetable may not be objectionable. On the contrary, it may assist 
the operation of the tonic principle, by exciting a new action in the 
nerves of the stomach ; but, where the powers of the system, and of 
the digestive organs as a part, have been prostrated by long protracted 
indisposition, the vegetable tonics cannot be administered, with pro- 
priety, in powder, — as they are apt, by reason of the indigestible woody 
matter, to occasion great derangement of the stomach and bowels, and 
sometimes irritative fever. At other times, the bark accumulates in such 
quantity in the alimentary canal as to be discharged by the bowels for 
several days consecutively. In a case of this kind, that fell under the 
author's care many years ago, the most disastrous results were produced, 
apparently by the irritation excited in the system by the presence of 
this extraneous substance in the bowels. A young lady, of markedly 
scrofulous temperament, and predisposed somewhat to pulmonary con- 
sumption, was attacked with bilious fever, which was actively treated, 
and, in the course of three or four weeks, yielded : the resulting de- 
bility, however, was so great as to induce the practitioner to prescribe a 
tonic ; and the cinchona was selected, and administered in powder. 
After she had taken it for some days, vomiting and purging occurred, 
accompanied with occasional chills of the most distressing character. 
Bark was discharged in quantities in the evacuations ; and, under the 
irregular actions thus excited, tubercles — already probably present in 
the lungs — proceeded to softening, and this most rapidly ; hectic fever, 
and every symptom attendant on the confirmed stage of pulmonary con- 
sumption, supervened, and she gradually sank under the malady; — yet 
no signs of phthisis were present prior to this derangement, produced 
by the bark in powder on a frame already debilitated by a previous 
malady. 

Where the object of the practitioner is simply to strengthen the 
debilitated gastric functions, the powdered tonics should not, therefore, 
be chosen. Modern chemistry has presented valuable gifts to therapeu- 
tics, by separating the active principles from several of the tonics ; and 
where this has not been done, simple infusion will generally extract all 
their virtues. The watery infusion is perhaps the best preparation ; — the 
spirituous combining an excitant principle, which may not always be 
indicated, where tonics are ; and it is well, where their administration 
has to be persevered in for a length of time, that the tonic should be 
varied. The system soon becomes habituated to the same agent; and, 
if another be substituted in its place for a few days, the use of the for- 
mer may be resumed with its pristine advantage. 

Therapeutical Application of Tonics. 

In the therapeutical employment of tonics, it is important to inquire 
whether some may not be better adapted for fulfilling the indications that 
may suggest themselves than others. 

Fever. — In febrile diseases, tonics cannot often be needed ; an 
accordingly, they are not much employed. The remarks made regar 
ing the use of excitants in fevers are applicable to tonics, except, that 



24 TONICS. 

the latter do not excite as much as the former, and, when cautiously 
used, not beyond the healthy standard. Simple tonics can, therefore, 
be prescribed, when excitants might be of doubtful propriety ; and—as 
before remarked— if the symptoms do not improve under their admin- 
istration, they can be discontinued at once, without any apprehension of 
the evil that might supervene on the sudden discontinuance of excitants. 
The vital elasticity is generally sufficient to restore the patient from the 
depression induced by fever ; and when it is not, the use of excitants 
—and the same may be said of tonics— will not often be found effective. 
They can, indeed, act only on the excitability, that remains in the sys- 
tem. The practitioner, however, will never hesitate to have recourse to 
them in those malignant forms of typhus, met with in jails, camps, and in 
the filthy, unventilated houses of the destitute ; as well as in every fever, 
whose symptoms approximate to such a condition. The sulphate of qui- 
nia, in the state of supersulphate, formed by the addition of a few drops 
of diluted sulphuric acid, is one of the most common agents prescribed 
in these cases ; although the watery infusion of many of the tonics,— as 
columbo, and gentian— is often recommended, and by some preferred. 

In the apyrexia of inter mittents, tonics are the sheet anchor of the 
physician, to which he trusts implicitly. Their mode of operation, in 
preventing diseases characterized by periodicity, is by no means clear. 
The only plausible theory is, that they produce a new impression upon 
the nerves of the stomach, and through them on the nervous system 
generally ; and that the new action, thus induced, is sufficient to break 
in upon the morbid chain that has been established. This view is, at 
least, strengthened by the fact, that a powerful emotion produces a simi- 
lar antiperiodic effect with the tonic ; may completely prevent an ex- 
pected attack; and, even after its inception, remove it. Accordingly, 
fear is ranked, by many practical writers, amongst the antiperiodics to 
be employed in ague ; and the efforts of the tractorizer, and the animal 
magnetizer, exert their influence in the same manner. 

It is not easy to explain this effect on the mind, or, indeed, the action of 
any of the class of tonics, under the idea which M. Broussais entertained 
of the pathology of intermittents ; — that they are intermittent gastro- 
enterics. " Every regular paroxysm of intermittent fever," he remarks, 
"is the sign of gastro-enteritis, the irritation of which is afterwards 
transferred to the cutaneous exhalants, which produce the crisis." Yet 
this state of gastro-enteritis is removed, and prevented by agents, which 
would scarcely seem appropriate for such a result ; — for example, by the 
peppers, as well as by the whole class of aromatic tonics. 

But, whatever objection may be made to the pathological views of 
M. Broussais on the subject of intermittents, his treatment is rational. 
It is, indeed, that which experience has shown to be most satisfactory. 
Intermittents, it is known, may wear themselves out ; but, it is a long 
and tedious process. Antiphlogistics simply have been found to have 
no effect in breaking in upon them. However useful they may have 
proved in lessening the duration of one of the stages of the paroxysm, 
they do not prevent the recurrence of the attacks. The employment of 
vegetable or mineral tonics is demanded, if the object of the physician 
be to put an end at once to the disease. The following proposition 



IN INTERMITTENTS. 25 

conveys aphoristically the ordinary treatment in intermittent fever, — a 
treatment which is sanctioned by the experience of ages, and is no 
emanation from the l physiological doctrine,' but rather opposed to its 
inculcations. " The surest method for the certain cure of inflammations 
with periodical exacerbations, is, to treat them at first by antiphlogistics 
during the hot stage, so as to render the apyrexia complete ; to continue 
this treatment after the paroxysm, if the apyrexia be not complete ; to 
give the cinchona, or rather the sulphate of quinia, and the other tonics, 
during the whole apyrexia ; to administer diffusible stimuli at the acces- 
sion of the rigors, and to return afterwards to cooling drinks when the 
hot stage is developed." (Broussais.) 

It is only, however, when the apyrexia is complete, that tonics can be 
administered, with full advantage, for the cure of intermittents. If 
plethora exist, or if there be hyperemia in any organ, these must be 
removed, before the antiperiodics are had recourse to ; unless, indeed, 
in those old obstructions of the parenchymatous viscera, which occa- 
sionally present themselves as evidences of former attacks of malarious 
disease. In the pernicious intermittents, too, which prevail in some 
countries to so great an extent, as in the Maremma district of Italy, and 
in some parts of this country, cinchona seems to be required before 
there is a complete apyrexia, for the purpose of arresting, as early as 
possible, paroxysms -that might prove fatal, by virtue of the irregular 
actions, the hyperaemise, which they are apt to induce in important 
organs. It happens, fortunately, that in these cases, there does not 
appear to be as much mischief induced by the premature administration 
of cinchona, or its active principle, as is often apprehended ; although 
M. Broussais, in the propositions cited, has depicted some of the evils 
which he considers likely to be produced by it. There are many observ- 
ing practitioners, who have administered cinchona, even in substance, 
a form in which it is most likely to disagree, in consequence of the 
quantity of insoluble woody matter, and who have been satisfied, that 
it has not added even to the intensity of the hot stage. Still less would 
this be likely to accrue from some of the more advisable forms of pre- 
paration. 

The author has often administered cinchona in powder in moderate 
doses, both in the healthy and moderately excited state of the system ; 
but without observing any augmentation of organic action induced 
by it. 

It is a good general rule to lay down, — that prior to the administra- 
tion of tonics, all local mischief must, if possible, be removed ; for, 
even should these agents not augment the mischief, they cannot exert 
the necessary sanative influence upon the morbid catenation that keeps 
up the fever. In the enlargements of the spleen, however, that accom- 
pany, or succeed, intermittent fever, sulphate of quinia, and subcarbo- 
nate of iron, in large doses, have been found excellent remedies. 

Remittent fevers have to be regarded much in the same light as the 
continued, in respect to the administration of tonics. Whilst the febrile 
irritation is nearly constant, or whilst there is no period when fever is 
almost, if not wholly, absent, they cannot generally effect a cure. The 
nearer the remittent approaches to an intermittent in its character, the 



TONICS. 



more beneficial will be their action. During the inflammatory period 
of the disease, antiphlogistics have to be relied upon exclusively ; and 
as there is generally a strong disposition to hyperemia in some impor- 
tant organ, during the continuance of the irregularity of functions that 
characterizes the remittent forms of fever, antiphlogistics have to be 
pushed to a greater extent than in simple fever. There are cases, how- 
ever, of remittent fever occurring in highly malarious districts, which 
demand the use of the bark, or quinia, comparatively early ; — the dis- 
ease, from the first, not exhibiting any highly phlogistic character ; and 
being apt to be attended with engorgements of internal organs, unless 
interrupted in its progress at an early period. In such cases, bark, or 
its active principle, has been found effectual. 

Inflammations. — It need scarcely be said, that tonics are not indi- 
cated in inflammatory disorders, unless in those forms, and stages, in 
which excitants may be advisable. It has, however, been maintained 
by men of no small distinction in science, that they may be given with 
advantage in every stage of erysipelatous inflammation, as well as of 
acute rheumatism. So far as the author's experience goes, these affec- 
tions differ somewhat according to the climate, or locality in which they 
occur ; and hence, in part, the diametrically opposite views of treatment, 
at one time inculcated in London and in Edinburgh — the antiphlogistic 
medication being universally adopted in the one place, whilst the tonic 
was as universally had recourse to in the other. Much also depends 
upon the habit of the individual, — whether healthy or modified by in- 
temperance, &c. In the latter case, the inflammation may be of, what is 
termed, the most unhealthy character ; adynamic fever may be present, 
with, at times, every sign of absolute typhus, and tendency to gangrene. 
In such a condition, tonics are indispensable. The practitioner must, 
however, be always guided by the symptoms that present themselves, 
and by the nature of the lesion, in this way indicated ; and if he prac- 
tices soundly, he will find, that, occasionally, it is requisite to push 
antiphlogistics ; whilst at other times the indication may be, to be 
equally active with tonics. Facts, in this case again, have shown, that 
tonics, although they may not always be productive of advantage, may 
still be administered with impunity. 

The remarks made on erysipelas apply generally to acute rheumatism, 
which is essentially arthritis or an inflammatory condition of the fibrous 
structures surrounding the joints, accompanied by a singular anomaly, 
— that the skin, instead of being hot and dry, as in other fevers, is 
usually hot and bedewed with copious perspiration. In such case, 
tonics have been freely exhibited, and have been looked upon, by some 
practitioners, as more beneficial, from the commencement even, than 
antiphlogistics. The author has had numerous opportunities for wit- 
nessing the exclusive use of both these modes of treatment; and although 
he cannot agree, that the tonic medication has been always the best, he 
does not recollect having seen the symptoms, in a single case, aggra- 
vated under their prudent administration. A combination of the two 
modes has appeared to him most advantageous ; — treating the disease 
during the earlier period, by the ordinary antiphlogistics ; and afterwards 
endeavouring to modify the condition of the nervous system by the 



IN LOCAL DISEASES, ETC. 27- 

cautious employment of tonics, such as the sulphate of quinia. The 
whole disease is peculiar. It is not dangerous whilst the joints remain 
chiefly affected ; and it only becomes so by the extension or translation 
of the rheumatic inflammation to more important organs. It has been 
the opinion of many eminent observers, that copious depletion favours 
this extension, or metastasis, whichsoever it may be ; but proof is want- 
ing. In our uncertainty, it is advisable not to be too officious, where, 
as already remarked, the disease is not situate in parts of vital import- 
ance, and usually terminates favourably, except under the supervention 
of the accidents just mentioned. 

Hemorrhage. — As in inflammatory diseases tonics are manifestly con- 
tra-indicated, so are they in the active forms of hemorrhage, the man- 
agement of which is essentially that adapted for inflammatory disor- 
ders ; but in the less active varieties ; in those that have been termed 
passive, in which there is loosened cohesion of tissue, and perhaps 
modified spissitude of the blood, so that it readily transudes through 
the coats of the vessels, the aid of all the forms of general excitants may 
be required. Tonics, on this principle, are employed in scurvy ; and 
in febrile and other affections, accompanied with strong evidences of a 
passive hemorrhagic tendency. 

Neuroses. — Many of the neuroses, being attended with considerable 
debility and mobility of the nervous system, require the employment of 
tonics. This is the case with epilepsy, which is more frequently de- 
pendent on this, than on any inflammatory, state of the nervous system. 
Not unfrequently, however, the disease is organic in its nature ; or, 
in other words, arises from some lesion of the encephalon. In such 
cases, tonics are not adapted to afford relief; but the cases are not easy 
of discrimination ; and a plan of treatment, adapted to the general con^ 
dition of the system, is usually had recourse to. This, as the author has 
said, must generally be of a tonic kind. 

The vegetable tonics are, in these cases, not equal to the mineral ; 
and, of the latter, the nitrate of silver is to be preferred, perhaps, to 
any other. The author has succeeded in removing many cases of 
epilepsy by its means; but it requires to be persevered with for a con- 
siderable time: It will rarely be found to exert any decided efficacy 
before the end of the first month. The preparations of zinc, copper 
and iron, are likewise employed ; but they are not usually as efficacious 
as the salt of silver. 

In chorea, the hopes of the practitioner are placed almost entirely on 
the appropriate use of tonics, combined with cathartics to remove the 
torpid state of the intestinal canal, that prevails in the disease. Here, 
again, the mineral tonics are preferred ; as well as in chlorosis, which 
commonly occurs in those in whom there is much torpor of the system, 
— characterized by pale and lurid complexion ; languor ; listlessness ; 
depraved appetite ; indigestion; palpitation, &c. 

In neuralgia, employed as a generic name for a number of diseases, 
the principal symptom of which is a very acute pain, exacerbating, or 
intermitting, following the course of a nervous branch, extending to its 
ramifications, and seeming, therefore, to be seated in the nerve, the 
plan of treatment by chalybeates has been found the most satisfactory. 



28 TONICS. 

In this painful malady, one variety of which has been long known under 
the name tic douloureux, the greatest diversity of agents has been made 
use of; — bleeding, general and local; emetics; purgatives; rubefa- 
cients; vesicants; cauterants; anodynes; mercurial frictions; electricity; 
division of the nerve, excision of a portion of it, &c, &c ; but one of 
the most successful is, undoubtedly, the subcarbonate of iron, given in 
large doses, — for instance, in thirty or forty grains twice or thrice a 
day. This course of treatment, continued for a month or two, often 
relieves, and ultimately removes the much dreaded affection. The 
mode in which it operates is by no means clear. It is, of course, 
through the nerves of the stomach, that any new action must be induced 
in the nervous system generally, and in the nerves affected with neural- 
gia in particular. Since its first introduction into practice for this pur- 
pose, by Dr. Hutchinson, of Southwell, England, upwards of twenty-five 
years ago, the author has had repeated opportunities for exhibiting it ; 
and often with the mo^st happy results. A lady had suffered under the 
most excruciating hemicrania, — essentially an intermittent neuralgia of 
one-half the encephalon, — for which depletion, anodynes, counter-irri- 
tants, &c, had been used in vain. She was confined to bed for more 
than half her time and suffered intensely ; yet the affection was com- 
pletely removed by the use of the subcarbonate, and although it is now 
more than twenty years since the cure was effected, the symptoms have 
not recurred. He could allude to many similar cases. 

Worms. — Bitters, and, indeed, the whole class of tonics, are anthel- 
mintic, or unfavourable to the generation of entozoa within the body ; 
but this subject occupies a distinct section. See Anthelmintics. They 
are likewise found to be serviceable in many 

Chronic cutaneous diseases, unaccompanied by febrile excitement, as 
in some varieties of strophulus, lichen, prurigo, psoriasis, &c, in which 
their efficacy is mainly perhaps exerted through the changes they induce 
in the blood ; and through that fluid on the vessels of the affected parts, 
— acting, therefore, as eutrophics, rather than tonics. 

Local diseases, fyc. — The surgeon, where gangrene is about to take 
place in any part of the frame, places his main reliance upon the em- 
ployment of tonics, administered internally, as well as applied to the 
gangrenous part, where this is practicable. For this purpose, cinchona, 
or its active principle, is found most effectual. . In short, in all cases, 
in which the powers of the system appear to be below the true stand- 
ard ; or, where the action of the nervous system is particularly impaired ; 
where the skin is pale ; the pulse feeble; the solids loosely cohering; 
and the ordinary indications of cachexia are present, tonics are de- 
manded ; and even in cases where the practitioner, owing to evidences 
of general febrile or local irritation, is doubtful whether they may be 
productive of advantage, he may venture upon their administration, 
when he would be afraid to use excitants. Too much dread is gene- 
rally inculcated, and entertained regarding them. The remarks of Dr. 
A. T. Thomson, on this point, are extremely just, and apposite. 
" Upon the whole," he says, " it is necessary that tonics should not 
be confounded with stimulants ; and although it is proper to prescribe 
them with caution in any form of fever complicated with local inflam- 



IN LOCAL DISEASES, ETC. 29 

raation, yet we ought not to be prevented by the dread of inflamma- 
tory symptoms from employing a class of remedies, so well calculated 
to restore the strength and vigour of the nervous system, essential for 
carrying on the functions of life. We must recollect that tone is not ex- 
citement, nor strength increased vascular action." 

The abstraction of caloric from the body, by the application of cold 
to the surface,— as by Cold Bathing,— has long been ranked amongst 
tonic agencies— with what propriety the author has considered elsewhere, 
(Human Health, p. 361). The direct effect of such abstraction is cer- 
tainly sedative; and, therefore, when the vital energies are too strongly 
exerted, it may, by reducing these, be indirectly tonic ; but if it be ex- 
hibited, when languor and diminished action pervade the frame ; during 
existing disease ; in the state of convalescence ; or in feeble 'infancy, 
the depressing effects of the application will be rendered manifest. In 
this respect, the cold and the hot bath are opposed to each other,— the 
former exerting a sedative, the latter an excitant action. The judgment 
is often misled by the feeling of glow over the whole surface, which fol- 
lows immersion in the cold bath, when a healthy individual has recourse 
to it. This feeling is fallacious : the reaction is not really as great as 
it appears to be, owing to the mind instinctively contrasting the existing 
sensation with the one immediately preceding it,— as it does, indeed, 
on all occasions. If we descend into a cellar in winter, and again in 
summer, we have, in the former season, the impression of warmth, and, 
in the latter, that of cold, although the temperature of the cellar may be 
nearly the same at both seasons,— a comparison being instinctively in- 
stituted between the temperature felt, in both cases, immediately pre- 
vious to the descent; and as, in the one case, the air above was colder 
and, in the other, warmer than that of the cellar, the feeling experienced 
in the room was, in the former case, that of augmented, and in the lat- 
ter of diminished temperature. 

Exercise is likewise a tonic, which may be employed with much ad- 
vantage in disease. When combined with mental amusement— such 
as travelling exercise affords— its salutary results are sometimes aston- 
ishing. 

When we regard the effects which active exercise is capable of in- 
ducing, and the degree of effort that is necessarily required, we can 
appreciate the cases in which it may be found advantageous, or the 
contrary. It is, of course, singularly inappropriate during acute diseases 
of any kind ; and as one of its chief effects is to augment the enemy of 
the circulation, and to cause the blood to circulate through every portion 
of the capillary system,— if hyperemia exist in any part of the frame, it 
may increase it ; whilst if obstructions be present to a triflino- extent 
only, the augmented impetus may tend to remove them. But even 
where active exercise is improper, the passive form may be adopted ; 
and the change of air and scene, thus afforded, unites with the motion 
in impressing a salutary influence on a frame debilitated by disease, 
ine author has elsewhere entered into the physiology of the different 
active and passive exercises, in a hygienic point of view ; and has 
suggested the various remedial and injurious results, that may be induced 



30 TONICS. 

• 

by any and by all of them. He will, therefore, confine himself to a few 
general observations for the guidance of the therapeutical inquirer. 

It is in the great class of nervous diseases that we find exercise — 
especially travelling exercise — so beneficial ; and it is surprising what 
an amount a feeble individual, under such circumstances, is capable of 
enduring without fatigue. Allusion has already been made to the sur- 
prising feats of strength executed by the maniac ; and by those whose 
encephalic functions are inordinately exalted. The resistance exhibited 
by the valetudinarian, whilst toiling over steep ascents in situations 
new, but of engrossing interest to him, must be accounted for in a simi- 
lar manner. This has been forcibly illustrated by Dr. James Johnson. 
" In the month of August, 1823," he says, "the heat was excessive at 
Geneva, and all the way along the defiles of the mountains, till we got' 
to Chamouni, where we were at once among ice and snow, with a fall 
of forty or more degrees of the thermometer, experienced in the course 
of a few hours, between midday at Salenche, and evening at the foot of 
the glaciers in Chamouni. There were upwards of fifty travellers here, 
many of whom were females and invalids ; yet none suffered inconve- 
nience from this rapid atmospheric transition. This was still more 
remarkable in the journey from Martigny to the great St. Bernard. On 
our way up through the deep valleys, we had the thermometer at ninety- 
two degrees of reflected heat for three hours. I never felt it much hot- 
ter in the East Indies. At nine o'clock that night, while wandering 
about the Hospice of St. Bernard, the thermometer fell to six degrees 
below the freezing point, and we were half frozen in the cheerless 
apartments of the monastery. There were upwards of forty travellers 
there — some of them in very delicate health ; and yet not a single cold 
was caught, nor any diminution of the usual symptoms of a good appe- 
tite for breakfast next morning." 

This resistance to deranging influences is more striking than strange. 
It is fortunate, that the condition of the functions, during an elevated 
temperature, still continues for a time after the temperature becomes 
depressed. Were it otherwise, the worst consequences might follow an 
immersion in the cold bath, after the system has been violently excited 
by the application of heat,— as is the practice with the Russians in their 
vapour baths ; as well as the sudden vicissitudes, to which the climate 
of the United States is liable. The same disadvantage would apply, 
although to a less extent, to a change of climate. The excited condi- 
tion of the capillaries of the surface, induced by excessive heat, sub- 
sides gradually when the temperature is suddenly reduced ; and in such 
a manner, that a power of resistance remains for a time ; hence it is, 
that we pass with impunity from a hot room, in the depth of winter, to 
the external air, the temperature of which may be greatly below the 
freezing point ; and a similar power of endurance continues for some 
time after a person has quitted a torrid, to reside in a temperate or frigid 
region, — and conversely. 

It is obvious, from what has been said, that the occupation of the 
mind by a succession of pleasing objects, constituting amusement, must 
be regarded as a tonic influence ; and many a valetudinarian, who quits 
the town during the summer, suffering under dyspepsia, or hypochon- 



TRAVELLING EXERCISE. 



31 



driasis, or worn down by some corroding or protracted malady, finds 
his uneasy feelings diappear, and himself almost renovated, before he 
reaches ihe end of his journey towards some of the fashionable water- 
ing places. A great deal of this effect is owing to simple change of air, 
so beneficial to the civic resident in a hygienic respect ; much, also, to 
exercise, and to change and appropriate regulation of diet ; but the 
chief part, perhaps, to the mental occupation afforded by varied scenery 
and society on the way. The whole physical circumstances surround- 
ing the individual are changed ; and he abandons himself to new im- 
pressions, which break in upon the monotony of the old. " It may be 
stated, without any risk of being mistaken" — says, recently, an able 
physician and writer — " that there are very few residents in large towns, 
particularly in our large manufacturing towns and in London, where 
such a tour as is described in the following pages, {A Physician's 
Holiday, or a Month in Switzerland in the Summer of 1848, by John 
Forbes, M. D., F. R. S., London, 1849,) will not benefit in a very 
marked degree. It will enable a large proportion of such persons to lay 
in a fresh stock of health sufficient to last through the year, in spite of 
all the exhausting influences of confined air, sedentary occupations, and 
that overtaxing of the mind to which so many of them are exposed, 
and which is the fruitful source of so many diseases. A journey of this 
kind, properly conducted according to the circumstances of the particu- 
lar case, will be still more beneficial to that numerous — I had almost 
said that innumerable — class of invalids who, although unaffected by 
any fatal or even dangerous disease, are yet so disordered and distressed 
by chronic functional derangements of various kinds, and by consequent 
debility, that their condition is much more to be pitied than that of the 
victims of the severest diseases of an acute kind. To these unhappy 
persons, whether their malady be in popular or learned phrase, ' bile,' 
'liver,' 'stomach,' ' dyspepsy,' 'indigestion,' 'mucous membrane,' 
' suppressed gout,' ' dumb gout,' ' nerves,' ' nervousness,' ' hypochon- 
driasis,' ' low spirits,' &c, &c, I will venture to recommend such a 
tour as that described in this little hook— mutatis mutandis — as more 
effectual in restoring health than any course of medicines, taken under 
the most skilful supervision at home. And to say truth, such a jour- 
ney may be made to fulfil almost every indication of cure applicable to 
such cases, which, however varied in appearance, are, in reality, ex- 
tremely similar in their more essential characters. 

" A course of travelling of this sort — to speak medically — carried 
out in the fine season, in one of the healthiest localities of Europe, in 
a pure and bracing air, under a bright sky, amid some of the most 
attractive and most impressive scenes in nature, in cheerful company, 
with a mind freed from the toils and cares of business or the equally 
oppressive pursuits, or rather no-pursuits, of mere fashionable life — will 
do all that the best medicines can do in such cases, and much that they 
can never accomplish. 

" It is now well known to all experienced and scientific physicians, 
that chronic functional diseases of long standing can only be thoroughly 
cured by such general and comprehensive means as act on the whole 
system, and for a certain period of time influencing the nutrition in its 



32 TONICS. 

source, not merely by the supply of wholesome elements, but by keep- 
ing the nutrient function active and vigorous over the entire fabric, by 
an equable distribution of blood and nervous influence, and consequent 
energetic action of all the secreting organs. When drugs are useful in 
such cases they are so only as subsidiary means, calculated to fulfil 
some special, local or partial indication. It need, therefore, excite no 
surprise, that a Course of Travelling, calculated as it is, or at least 
may be made, to fulfil all the foregoing requisites, should be held forth 
as one of the most important methods of curing many chronic diseases." 

Confidence and hope must likewise be esteemed valuable tonics. 
The author has previously described the influence exerted by confi- 
dence in the physician on the action of his remedial agents, — as well 
as the great advantage to the patient, in several malignant diseases, that 
he should not give up hope, ' the sick man's health,' but, on the con- 
trary, should cherish it as one of the most influential agencies in his 
recovery. It has been properly said by a distinguished poet, himself a 
physician, that 

* whatever cheerful and serene 
Supports the mind, supports the body too; 
Hence, the most vital movement mortals feel 
Is hope ; the balm and lifeblood of the soul ; 
It pleases, and it lasts." 

Armstrong. 

Every practitioner must have observed the tonic effect of hope, where 
it has been enthusiastically indulged ; and, on the other hand, the 
blighting results of hope deferred, or lost. It is a common saying, that 
the physician might as well destroy a patient as tell him there is no 
hope ; and in certain affections this is an approximation to the fact. 
Where the functions are already greatly depressed, such a communica- 
tion is likely to add to the depression. Perhaps in no case was the cor- 
roding effect of mental anxiety and doubt more exemplified than in the 
nostalgia, which was so common during the domination of Napoleon; 
when young conscripts were torn from their families and friends, and 
forced into foreign and far distant countries ; — a disease, which has 
been said so frequently to affect, also, the Swiss, who have left their 
homes and their country to dwell in other climes, with little prospect, 
perhaps, of a return. Rogers has a beautiful allusion to this H e i m w e h, 
or ' HomeacheJ as well as to the influence of association, in his 'Plea- 
sures of Memory :' — 

" The intrepid Swiss, who guards a foreign shore, 
Condemn'd to climb his mountain cliffs no more, 
If chance he hear the song so sweetly wild, 
Which on those cliffs his infant hours beguiled, 
. Melts at the long lost scenes that round him rise, 

And sinks a martyr to repentant sighs." 

The effects of mental tonics on the system, especially those of hope 
and confidence, are well exhibited in the following extract from the 
work of Dr. A- T. Thomson, to which the author has so often referred. 



SPECIAL TONICS. 33 

" Were any thing requisite to prove the power of mental tonics in dis- 
ease, it would only be necessary to refer to their influence in sustaining 
the body under fatigue which could not otherwise be borne. What is 
it' but hope and confidence, which enable, a mother, night after night, 
to watch at the bedside of a sick infant ? to bear up, even with a weak 
and delicate frame of body, under fatigues which no stranger could 
sustain, and yet, if the object of her solicitude recover, to suffer no 
inconvenience from the exertion : — take away the tonic powers of hope 
and confidence, or let all her attentions prove unavailing and her infant 
fall a victim to the malady, then her health will give way, she will feel 
the exhaustion which naturally follows exertions too powerful for the 
strength of her body to sustain with impunity, and fall a victim of the 
anxiety and watching, under which hope and confidence had so long 
borne her up, and which could alone sustain her by their tonic powers. 
Nothing can exceed the truth, as well as the beauty of the passage in 
Milton's description of the Lazar-house, in which the greatest evil is 
the absence of hope : — 

' A lazar-house it seem'd wherein were laid 

Numbers of all diseased, all maladies 

Of ghastly spasm, or racking torture, qualms 

Of heartsick agony, all feverous kinds, 

Convulsions, epilepsies, fierce catarrhs, 

Intestine stone and ulcer, colic pangs, 

Demoniac phrenzy, moping melancholy, 

And moonstruck madness, pining atrophy, 

Marasmus, and wide-wasting pestilence, 

Dropsies, and asthmas, and joint racking rheums. 
jDire was the tossing, deep the groans ; despair 

Tended the sick busiest from couch to couch ; 

And over them triumphant death his dart 

Shook, but delay'd to strike, though oft invoked 

With vows, as their chief good and final hope.' 

Despair, indeed, in every instance where disease falls upon mortality, 
may be regarded as bearing the standard in the van of death." 



SPECIAL TONICS. 

It has been before remarked, that tonics are given with one of two 
views, — either to make a decided impression on the nervous system, so 
as to break in upon a chain of morbid phenomena that supervene' in 
paroxysms,— as in intermittent fever ; or to produce a silent but per- 
manent operation for the removal of debility ; and, although some of 
them are capable of acting in both ways, there is convenience in classi- 
fying them separately ;— into first, simple tonics ; and secondly, anti- 
periodic tonics. The former may admit again of farther subdivision, 
according to the principles which they contain ;— into first, such as owe 
their tonic virtues to bitter principle singly ; secondly, those that possess, 

Vol. II. — 3 



34 



SPECIAL TONICS. 



along with the bitter principle, more or less aromatic property ; thirdly, 
such as have an astringent associated with the bitter principle ; fourthly, 
such as seem to act mechanically ; and fifthly, mineral tonics. 



I. Simple Tonics. 

a. Bitter Tonics 
that owe their tonic virtues to bitter principle singly. 

1. COLOM'BA.— COLUM'BO. 

This is the root of Cocculus palmatus ; Sex. Syst. Dioecia Hexandria ; 
, Fi 124 Nat. Ord. Menisperma- 

ceae ; a climbing plant, 
which inhabits thick fo- 
rests on the shores of Oibo 
and Mozambique ; and fif- 
teen or twenty miles inland. 
It has been cultivated both 
at Madras and the Isle of 
France. The roots are dug 
up in the hot season in 
March ; the tubers only 
being generally removed, 
without injuring the pri- 
mary root.^ These are cut 
into slices and dried on 
cords in the shade. Co- 
lumbo is imported largely 
into England, but the quan- 
tity seems to fluctuate great- 
ly in different years. Thus, 
in 1838, according to Dr. 
Pereira, duty was paid on 
19,805 lbs; and in 1839, 
on only 9,384 lbs. 

Columbo or Colomba 
root, as met with in the 
shops, is in flat, circular 
or oval pieces, from half an 
inch to three inches in di- 
L-M~ / # ) ameter, and from one to 

Coccuius paimatua. three or four lines thick. 

a Male flowers, b Calyx, c Stamen, d Petal, e Bract. The epidermis is of a yel- 

lowish gray or brownish colour ; smooth or irregularly wrinkled. The 
flat surfaces are of a greenish or grayish yellow colour, depressed in the 
centre from shrinking during drying, and are frequently marked with 
concentric circles and lines radiating from the centre. 

It readily imparts its principles to alcohol and water. The tonic 




GENT I AN A. 



35 




principle or Columbin is obtained by evaporating an ethereal tincture 
until crystals are obtained, which are most intensely bitter. The root 
contains, also, a third of its weight of starch, which renders it an easy 
prey to insects. 

On the continent of Europe, it is said, that the root of Frasera 
Walteri has been sold Fi g# \^ 

for Columbo ; but they . 3 

differ so much from 
each other in appear- 
ance that the fraud is 
readily detected. 

Columbo is one of 
the very best of the 
bitter tonics ; and is 
greatly used as a sto- 
machic in all cases in 
which a simple bitter 
is needed. The best 
form of preparation is 
the infusion, but should Cocculus palmatus . 

it be desired tO admin- j- ^ Petals. 3, Ovaries united at the base. 4, Drupes or berries, 
ister it in DOwder the 7,' Spindle-shaped fleshy tubers. 8, Transverse section of the same. 

dose may be from gr. x to 3ss and more. 

LWSUM COLOMBO, INFUSION OF COLUMBO. (Colomb. contus. |ss; Aqua 
bullient. Oj.) Boiling water dissolves some of the starch in which co- 
lumbo abounds ; and, hence, the Edinburgh College directs the infusion 
to be made with cold water, which thoroughly exhausts the root, if used 
in the way of percolation or displacement; and makes an infusion, that 
keeps longer without becoming mouldy. The infusion, made in the 
ordinary way, soon spoils. 

It is often given along with alkalies ; and forms the excipient, if not 
the basis, of numerous tonic mixtures. The dose is f.^iss to f.^ij. 

TINCTU'RA COLOMBO, TINCTURE OF COLUMBO. {Colomb. cont. §iv ; Al- 
cohol, dilut. Oij ; made either by maceration or displacement.) This 
tincture is a good adjunct to bitter infusions, as to the infusion of co- 
lumbo ; and is, occasionally taken alone, mixed with water. Its dose 

is from f.3j to f.giij. 

( 

2. GENTIA'NA.— GENTIAN. 

Gentian is the root of Gentiana lutea, common or yellow gentian ; 
Sex. Syst. Pentandria Digynia ; Nat. Ord. Gentianaceae. It may be 
regarded as the best of the simple bitters. Accordingly, it is received 
into the various pharmacopoeias; and its officinal preparations are more 
numerous than those of any article of the class. The plant is an inhabi- 
tant of Alpine grassy slopes and meadows throughout the middle regions 
of continental Europe ; and abounds in the Pyrenees, the mountains of 
Vosges and Auvergne, and the Alps of Austria and Switzerland, thriving 
best at an elevation between 3000 and 5000 feet above the sea. It is 



36 



SPECIAL TONICS. 



said to be particularly abundant on Mount Jura. (Christison.) It is 



Fig. 126. 




Gentiana lutea. 



a beautiful plant, evolv- 
ing its splendid yellow 
flowers in July. The 
root, which is the only 
officinal part, is brought 
to this country from 
Germany. It is said 
to be imported into 
England from Havre, 
Marseilles,&c. In 1839, 
according to Dr. Perei- 
ra, duty was paid on 
470 cwt. 

As met with in the 
shops, gentian is in 
pieces of various sizes ; 
and, if large, is split 
lengthwise. Itisyellow- 
ish-brown externally, 
and of a brownish-yellow within; and is tough and flexible; but, when 
thoroughly dried, is readily reduced to a yellowish-brown powder. Its 
odour is feeble and peculiar ; taste at first sweet, but afterwards intensely 
bitter. It yields its virtues readily to water, alcohol, and wine, which 
are therefore used as menstrua for certain officinal preparations. When 
subjected to analysis, it is found to consist mainly of bitter extractive, 
traces of volatile oil — oil of gentian ; — gum, an uncrystallizable principle, 
and gentisic acid or gentisin. MM. Henry and Caventou believed, that 
they had succeeded in separating, by means of ether, an active neutral 
crystalline principle of a yellow colour, in which the bitterness of the root 
was concentrated, and to which they gave the name Gentianin ; but 
this has since been shown to be impure gentisic acid ; and when the 
crystals are entirely free from impurities, they are devoid of bitterness. 
(Leconte, TrommsdorfT.) The bitter principle of gentian has not yet 
been isolated. 

Gentian, as already remarked, is one of the bitters most extensively 
prescribed. It is, indeed, calculated to fulfil all the objects for which 
the simple bitter tonics are employed. Accordingly, it may be given 
in atonic dyspepsia, simple or complicated ; as well as in convales- 
cence from acute diseases ; and in want of tone, howsoever induced. It 
is an ingredient of the celebrated Duke of Portland's powder for the 
Gouty which consisted of equal quantities of the roots of gentian and 
birthwort {Aristolochia rotunda), the tops and leaves of germander 
(Chamadrys), ground pine (Chamcepitys), and lesser centaury ( Chironia 
centaurium), powdered, and mixed together. This powder, as well as 
gentian itself, was at one time thought to possess the power of arresting 
a paroxysm of gout, and of eradicating the disease ; and, as the affec- 
tion is connected with derangement of the gastro-enteric functions, it 
may, doubtless, often be serviceable ; but it need scarcely be said, that 
it does not merit the high encomiums that have been passed upon it. 



GENTIANA. 37 

The dried root is sometimes used by the surgeon as a tent to dilate 
apertures. The powder is occasionally employed to promote the dis- 
charge from issues. 

INFU'SUI GENTIAM COMPOS'ITUM, COMPOUND INFUSION OF GENTIAN. 

(Gentian, cont. 3ss; Aurant. corticis cont., Coriandr. cont. aa -z) ; 
Alcohol, dilut. f-5iv ; Aqua f.^xij.) This is really a weak tincture of 
gentian, with the addition of certain aromatics, which render it abetter 
stomachic. The alcohol enables the infusion to keep better than if 
water only were the menstruum. The dose is f.5j to f.5iss. 

TEVCTU'RA GENTIAM COMPOS'ITA, COMPOUND TINCTURE OF GEN'TIAN. 

{Gentian, cont. 2ij ; Aurant. cort. %] ; Cardamom, cont. §ss. Alcohol, 
dilut. Oij ; prepared either by maceration or displacement.) This is an 
excellent stomachic, which is either added to bitter infusions like the 
one above ; or is taken alone, mixed with water. The aromatics and 
alcohol cause it to be excitant; and suggest caution in its employment, 
where there is hyperemia of the mucous membrane of the stomach. It 
is apt to be indulged in by hard drinkers, whose gastric functions be- 
come impaired ; and who, in this manner, without reflection may take 
considerable quantities of alcohol. The dose of the tincture is f.Jj 
or f-3ij. 

EXTRAC'TUM GENTIAM, EXTRACT OF GENTIAN —Extract of gentian may 
be made either by evaporating a decoction of the root, or the cold infu- 
sion made by percolation or displacement. The latter is the plan recom- 
mended in the Pharmacopoeia of the United States. Good gentian yields, 
by the former method, about half its weight of extract. (Brande.) Ex- 
tract of gentian may be prescribed alone as a tonic ; but it is more fre- 
quently used as a vehicle for other tonics, as the preparations of iron. 
When given alone, the dose is from gr. x. to gr. xxx. 

Gentian also forms part of the Tinciura Rhei et Geniiance of the 
Pharmacopoeia of the United States. 

3. Gentia'na Chirayi'ta, Henrice'a Pharmacear'cha, Swer'tia chiray- 
i'ta, Agatho'tes Chirayi'ta, Chiretta, Chirayi'ta, is a native of India, 
whence it is imported into England tied up in bundles. It has been 
long in use there. The herb and root are intensely bitter. They stri- 
kingly resemble officinal gentian, and are employed in the same cases 
either in infusion, (Gent. Chirayit. §ij ; Aq. bullient. Oss ; or in tinc- 
ture, Gent. Chirayit. ^v; Alcohol, dilut. Oij. Dose, one or two tea- 
spoonfuls.) The dose of the powder is a scruple. 

Other species of gentian — as Gentiana biloba or G. punctata; G. 
purpurea ; G. macrophylla ; G. Pannonica, possess properties analo- 
gous to those of gentiana lutea ; and the roots of some of them are 
occasionally substituted for it. One other species is officinal, in the 
secondary list of the Pharmacopoeia of the United States, the 

4. Gentia'na Catesb.e'i, Blue Gentian. This species of gentian is 
indigenous in the swamps of the Carolinas, where it flowers from Sep- 



38 



SPECIAL TONICS. 



tember to December. Its properties resemble those of Gentiana lutea; 
and it may be given in the same cases, dose, and forms of preparation. 

5. QUAS'SIA. 



127. 



Quassia wood was at one time obtained from Quassia amara ; Sex. 
Syst. Decandria Monogynia ; Nat. Ord. Simarubacese, a tree, which 

inhabits Surinam, 
Guiana, and Ce- 
lombia ; and is cul- 
tivated, as an orna- 
mental plant only, 
in Brazil and the 
West Indies. Its 
wood is light, yet 
close and tough; of 
a pale yellowish 
white colour, with- 
out smell, and of 
an intensely bitter 
taste. It is proba- 
ble, however, that 
this — true quassia 
wood — is never 
met with in com- 
merce. Dr. Chris- 
tison states, that he 
has often tried to 
obtain it from 
wholesale dealers 
in London ; but 
none of the billets 
sent to him corres- 
ponded with true 
quassia. 

The quassia now 
met with in the 
4. Drupe. s hops, is the wood 
of a different species— Quassia excelsa or Picrcena excelsa, Lofty Bit- 
terwood Tree, Bitter J2sh—a tall beautiful tree, nearly 100 feet in height, 
which inhabits Jamaica, and other West India islands. The wood is 
generally in cylindrical billets of various sizes ; is very tough ; yellow- 
ish ; without odour, and of an intensely bitter taste, and is kept in the 
shops either split into small pieces or rasped. It is said to be sometimes 
adulterated with other woods ; but these are detected by their not pos- 
sessing the intense bitterness of the genuine article. When subjected to 
analysis it affords traces of volatile oil; a bitter principle termed quas- 
site or quassin; gummy extractive ; pectin ; woody fibre, and various 
salts. The crystalline principle called quassite, which was discovered 




1. Male flower. 2, 



Quassia excelsa. 
Flower expanded. 3. Fertile flower. 



SIMARUBA. 39 

by Wiggers in some of the quassia woods, is not — it has been said — 
contained in the true quassia, although this last has a large amount of 
bitter principle. Dr. Christison affirms, that he has not been able to 
obtain it. 

The virtues of quassia are yielded to alcohol and water. 

Quassia possesses the medical properties of the simple bitters, and is 
adapted for all the cases in which the class are indicated ; hence, it is 
largely prescribed, and especially in asthenic conditions of the digestive 
organs. It is often used in place of hops in the preparation of beer, 
although prohibited by the statutes of certain countries. It does not, 
however, communicate any noxious property to the beer ; but does not 
preserve it as well as hops, or make as agreeable a beverage. Like 
other bitters, it is best given in the form of infusion. It is extremely 
difficult to reduce it to powder ; and the powder — as remarked of sim- 
ple bitter tonics in general — is an objectionable form in cases of gastric 
debility. If it be desired, however, to exhibit it, the dose may be 9j 
to 3j? three or four times a day. 

INFU'SUM QUAS'SI^l, INFUSION OF QUAS'SIA. (Quassias rasur. gtj ; Aqua 
Oj.) Cold water makes a clearer infusion than hot. The dose of the 
infusion is f.giss to f.^iij. 

TINCTU'RA WARM, TINCTURE OF QUASSIA. {Quassia rasur. |ij ; Alco- 
hol dilut. Oij ; prepared either by maceration or displacement.) Alcohol 
is said to make a better tincture than the dilute alcohol directed by the 
pharmacopoeias. 

This tincture is employed chiefly as an addition to bitter infusions. 
When given alone, the dose is f.3j or f-3ij, in a little water. 

EXTRAC'TUI QUAS'SLE, EXTRACT OF QUASSIA. This preparation is ob- 
tained by boiling down the cold infusion, made by displacement, to the 
proper consistence. Its chief use — like the extract of gentian — is as 
an excipient for the administration of the mineral tonics. In the dose of 
five grains, it may be prescribed by itself as a bitter tonic. 

6. SIMARU'BA. 

Simaruba is the bark of Simaruba officinalis, S. amara, Quassia 
simaruba, Bitter simaruba, Mountain damson ; which is of the same 
class and order, and the same natural order, as Quassia amara. The 
tree is common in Jamaica, and in other West India Islands ; and in 
Guiana and Cayenne. The bark of the root is the officinal portion. 
As met with in the shops, it is in pieces of various sizes, which are 
sometimes very long, and some inches in breadth ; folded lengthwise ; 
rough externally ; warty, and of a grayish-yellow colour; within, of a 
yellowish-brown, and on the inner surface of the bark of a pale yellowish- 
white. It is light and tough ; devoid of odour, and of a very bitter taste. 
When subjected to analysis, it is found to contain a bitter principle 
analogous to quassite, with a trace of volatile oil, &c. Water and 
alcohol extract its virtues. 



40 



SPECIAL TONICS. 



Fig. 12S. 




In large quantities, simaruba 
is said to excite vomiting and 
purging; but in ordinary medici- 
nal doses, it is a bitter tonic, 
resembling in its properties the 
article last described. It has, 
likewise, been given in dysentery, 
and the Germans term it 
Ruhrrinde, dysentery bark. 
It can only, however, be service- 
able in chronic cases of the 
disease ; and its action is probably 
altogether that of an ordinary 
bitter tonic. It is rarely prescribed 
in this country. The Pharma- 
copoeia of the United States con- 
tains no officinal preparation of 
it. The dose of the powder is 
from a scruple to a drachm. 



7. PRUNUS VIRGINIA'NA. 
CHERRY BARK. 



-WILD 



Simaruba amara. 

1, Female flower. 2. Drupes. 3. Male flower. 

4. Stamen. 



Prunus Virginiana, Cerasus 
serotina or Cerasus Virginiana ; 
Sex. Syst. IcosandriaMonogynia; Nat. Ord. Amygdalacea3 — an indige- 
nous tree, which is common throughout the United States — yields officinal 
Wild cherry bark. On the banks of the Ohio, it is a much larger tree 
than in the Eastern states. 

The inner bark which is the part of Prunus employed in medicine — 
as met with in the shops, is in pieces of various sizes, of a bright cinna- 
mon colour ; brittle and readily reducible to a fawn coloured powder. 
Its taste is agreeably bitter and aromatic, with the flavour of the bitter 
almond. Its virtues are readily communicated to hot or cold water ; 
but they are impaired, and the flavour injured by decoction, partly in 
consequence of the volatilization of principles on which they are de- 
pendent ; and partly of a chemical change effected by the heat. (Wood 
and Bache.) On distilling the same portion of water successively from 
several different portions of the bark, a volatile oil, associated with hy- 
drocyanic acid, was obtained by Mr. Procter, of Philadelphia, having 
properties analogous to those of oil of bitter almonds; and, like it, not 
pre-existent, but resulting from the reaction of water upon amygdalin. 

The medical virtues of Prunus Virginiana, are those of a tonic; and, 
also, of a sedative, owing to the hydrocyanic acid, which is formed ; — 
the tonic virtue being dependent upon the bitter principle, and— it has 
been suggested— on phloridzin. In this country, it is much prescribed 
in the debility attending phthisis; in which it has been supposed to 
act as a sedative on the accompanying hectic ; whilst at the same time 
it impresses a tonic influence on the stomach. It need scarcely be said 
however, that but little — even temporary— benefit can be expected from 
it in such cases, which— when in their confirmed stage— proceed 



FRASERA. 



onward to their fatal termination, unmodified, perhaps,/ 
In many of our hospitals, prunus is a routine prescriptio/ 
the author has carefully watched its effects, he has not/ 
that any evident relief was afforded by it. He has certa»w^ 
nessed the sedative action that has been ascribed to it. It may be b 
in all cases in which a mild unstimulating tonic is needed. 

As in the case of other bitter tonics, the infusion is a better prepara- 
tion than the powder ; but should it be desired to exhibit the latter, the 
dose may be from ^ss to 3j« 

IMJ'SUM PRUNI VIRGINIAM, INFU'SION OF WILD CHERRY BARK.— (Prun. 

Virginian, cont. §ss; Jiquse Oj.) Cold water is used in the preparation 
of this infusion, to avoid the disengagement of any volatile matter that 



may be possessed of activity, 
times a day. 

A Syrup or Wild Cherry, 
although not officinal, is much 
used, like other syrups, in 
bronchitic affections. 

8."jFRASE'RA — AMERICAN CO- 
LUM'BO. 

The root of Frasera Wal- 
leri, American Columbo or 
False Columbo ; Sex. Syst. 
Tetrandria Monogynia ; Nat. 
Ord. Gentianaceaa, is officinal 
in the secondary list of the 
Pharmacopoeia of the United 
States. The plant is one of 
the most beautiful indigenous 
productions of the vegetable 
kingdom ; flowering from May 
to July and flourishing in the 
southern and western portions 
of the Union, especially in 
Arkansas and Missouri. The 
root, it is advised, should be 
collected in the autumn of 
the second, or the spring of 
the third year; and, before be- 
ing dried, should be cut into 
transverse slices. (Wood & 
Bache.) When dried it is 
generally in transverse circu- 
lar segments, about an inch in 
diameter, and an eighth of 
an inch or more in thickness. 
Some years ago, it was intro- 
duced into France, and sold 
for columbo ; but if attention 



The dose is f.^iss— f.5iij, three or four 

Fig. 129. 




Frasera Walteri. 



4^2 



SPECIAL TONICS. 



be paid to the pieces, they will be found to be more uniform in their 
internal structure ; and not to have the concentric and radiating lines, 
which are generally seen on columbo. They are of a purer yellow, 
too ; without a greenish tinge, and contain no starch. 

Frasera has the same properties as columbo and other simple bitters, 
and is applicable to the same cases. It is not, however, much used. It 
maybe given in infusion; (Fraser. E] ; Aquas bullient. Oj. Dose; 
f.5iss — f.^ij ;) or in tincture (Fraser. 3j ; Alcohol, dilut. Oj. Dose f.3j 
— f.3iij,) neither of which is officinal. Should it be desired to give the 
powder, the dose may be gr. xx to gj. 

9. SABBA'TIA.— AMER'ICAN CEN'TAURY. 

Sabbatia angularis ; Sex. Syst. Pentandria Monogynia ; Nat. Ord. 
Gentianaceae, grows extensively in the Middle and Southern states of 
the Union, in low grounds especially ; flowering in July and August. 
The herb is collected whilst in flower. It has a strong bitter taste ; and 
its virtues are extracted by both alcohol and water. 

It may be prescribed in the same cases as gentian ; and, like all the 
bitters, has been given in the apyrexia of intermittents ; but its powers 
are not such as to entitle it to be classed amongst the antiperiodic 
tonics. It is generally given in infusion. (Sabbatice gj ; Aq. bullient. 
Oj. Dose, f.giss.) Should it be desired to prescribe it in powder, the 
dose may be from 3 s s to 5j- 

10. COPTIS.— GOLD-THREAD. 

Gold-thread is the root of Cophs trifolia ; Sex. Syst. Polyandria 
Fig. 130. Polygynia; Nat. Ord. 

Ranunculaceae ; a small 
indigenous evergreen, re- 
sembling the strawberry, 
which inhabits the north- 
ern parts of America ; 
and is found, likewise, in 
Asia, Greenland, and Ice- 
land ; flowering in May. 
The whole of the plant is 
bitter ; but the root most 
so. It is, therefore, the 
officinal portion ; and is 
admitted into the second- 
ary list of the Pharmaco- 
poeia of the United States. 
As seen in the shops, 
^^^ gold-thread is in loose 
fc^jK^ masses, formed by long 
filiform, orange yellow 
roots, frequently mixed 
with the stems and leaves. 
The taste is purely bitter, 




Coptis trifolia. 



. ANTHEMIS. 43 

and, like the other bitters, its virtues are communicated to water and to 
alcohol. The bitter extractive is precipitated by nitrate of silver, and 
by acetate of lead. 

Gold-thread is a simple bitter, which has been compared to quassia ; 
and may be used in all cases, where the simple bitter tonics are indi- 
cated. Like them,_it may be given in infusion {Copt. ?j ; Aquae bul- 
lient. Oj : dose; f.|iss — fljij); or tincture, {Copt. |j ; Alcohol, dilut. 
Oj : dose ; f.Jj — f.^iij) ; but neither of these is officinal. Should it be 
desired to exhibit the powder, the dose may be from gr. x to 3ss. 



Besides the simple bitter tonics already described, the secondary list 
of the Pharmacopoeia of the United States contains the following : 

11. Ale'tris, Star- grass. The root of %Bletris farinosa ; Star- 
grass, Blazing Star, Mealy Starwort ; Sex. Syst. Hexandria Mono- 
gynia ; Nat. Ord. Asphodelese ; an indigenous plant, which is found 
in almost all parts of the United States ; in fields and about the edges 
of woods ; flowering in June and July. Dr. Bigelow states, that he 
knows of no plant, which surpasses it in genuine, intense and perma- 
nent bitterness. The bitterness is owing to bitter extractive ; but the 
root likewise contains resin ; for when water is added to the alcoholic 
tincture, it becomes milky. It may be given as a tonic in infusion or 
tincture. In large doses, it is said to disturb the stomach. 

12. Xanthorrhi'za, Yellow-root. The root of Xanthorrlnza apii- 
folia or X. tinctoria, Sex. Syst. Pentandria Polygynia ; Nat. Ord. 
Ranunculaceae — which grows in the Southern and Western States, flow- 
ering in April — is so called in consequence of its colour, which, as well 
as its bitter taste, it yields to water and to alcohol. It is a simple bitter, 
resembling columbo ; and is prescribed in the same cases. It may be 
given in infusion. {Xanthorrhiz. ^j ; Aquae bullient. Oj. Dose; f.5iss 
to f.Jiij. 



Hydrastis Canadensis, Yellow root, Orange root; an indigenous 
plant, Nat. Ord". Ranunculaceae, which is found in most parts of the 
United States, but is most common to the west of the Alleghanies, and 
flowers in April and May, possesses the properties of the bitter tonics ; 
but it has not been analyzed. It is best given in infusion. It is said to 
have been used in this form in the Western States as a wash in ophthal- 
mia ; and the Indians employ it as a lotion to chronic ulcers. 



44 SPECIAL TONICS. 

b. Aromatic Bitter Tonics, 
that possess, along with bitter principle, more or less aromatic property. 

13. AN'THEMIS.— CHAMOMILE. 

The most important constituents of chamomile flowers — as elsewhere 
remarked (i. 137) — are volatile oil, and bitter extractive. They con- 
tain likewise a little tannic acid. In large doses — as has been seen — 
the infusion acts as an emetic ; in smaller quantities, as an aromatic bit- 
ter, — the volatile oil communicating the aromatic or excitant property; 
the bitter extractive and tannic acid, the tonic. In all cases, conse- 
quently, that require the union of an excitant and bitter, as in atonic 
dyspepsia, an infusion of chamomile is a good prescription ; and, ac- 
cordingly, it is largely used both in professional and popular practice. 

Powdered chamomile — for reasons often referred to — is rarely given 
as a tonic ; but should this be considered advisable, the dose may be 
from gr. x to >>ss, or more. An extract, prepared from the decoction, 
is directed in some of the pharmacopoeias ; but it cannot possess the 
virtues of an aromatic bitter, in consequence of the volatile oil being 
driven off" during the decoction. It has, consequently, been very pro- 
perly omitted in the last edition of the Pharmacopoeia of the United 
States (1842), — the extracts of the simple bitters — Gentian and Quas- 
sia — possessing all its properties. 

14. CASCARIL'LA. 

Cascarilla is the bark of Croton Eleutheria, and other species of 
Croton ; Sex. Syst. Monoecia Monadelphia ; Nat. Qrd. Euphorbiaceae. 
Croton Eleutheria is a small tree or shrub, which is indigenous in the 
West Indies, especially in the Bahama Islands, and in Jamaica ; from 
the former of which it is chiefly exported. In the year 1840, duty, 
according to Dr. Pereira, was paid in England on 14,490 lbs. ; but the 
whole of this was not used in medicine. It is a constituent of most of 
the fumigating pastilles, on account of the agreeable aromatic odour ex- 
haled by it when burning. 

Cascarilla is met with in pieces seldom exceeding from four to six 
inches in length, which are commonly quilled, but sometimes almost 
flat ; of a gray colour externally, with some portions almost white, and 
others yellowish-brown; of a brown colour internally, and usually 
shining. The epidermis is intersected by numerous longitudinal and 
transverse cracks or fissures. It is compact, hard, and readily reduci- 
ble to powder. The taste is warm, aromatic, and bitter ; and the smell 
peculiar and agreeable, and increased by heat. Alcohol and water 
readily extract its medical virtues, which are dependent on a bitter prin- 
ciple, associated with volatile oil. It is, consequently, well adapted for 
cases which require the aromatic tonics,— as asthenic dyspepsia, and, 
indeed, debility in general. At one time, it was used as an antiperi- 
odic ; but it is now never given with this view. 

Should it be desired to prescribe powdered cascarilla, the dose may 
be from 9j to 3ss. J 



SERPENTARIA. 45 

fflFU'SUM CASCARIM, INFU'SION OF CASCARIL'LA. (Cascarillce contus. Ij ; 
Aquce bullient. Oj.) The close of this infusion — -the form in which 
cascarilla is usually prescribed — is f.5iss to f.iiij. 

15. ANGUSTU'RA.— ANGUSTU'RA BARK. 

Angustura or Angostura or Cusparia Bark, is obtained from Galipea 
officinalis ; Sex. Syst. Diandria Monogynia; Nat. Ord. Rutacese ; 
which is indigenous in the neighborhood of the Orinoco. 

MM. Humboldt and Bonpland, however, assert, that Galipea Cusparia, 
Bonplandia trifoliata, Cusparia febrifuga, yields the bark ; and there 
is reason to believe, that from both trees a bark is obtained much alike 
in medical virtues. The framers of the last edition of the Pharma- 
copoeia of the United States refer the officinal bark to Galipea officinalis. 
As seen in the shops, the bark is in flat pieces, slightly curved, but 
rarely entirely quilled ; of various sizes ; covered by a yellowish-gray, 
or grayish-white spongy epidermis, which is readily scraped off with 
the nail ; the inner surface is brownish ; the transverse fracture short 
and resinous. The powder is of a pale yellow, somewhat like that of 
rhubarb. The odour is peculiar, and the taste bitter, acrid, and aro- 
matic. Its medical virtues are imparted to water and to alcohol. 
The bark has been subjected to analysis, and found to contain a volatile 
oil, to which it owes its acrid aromatic taste ; and a peculiar bitter 
principle called Angosturin and Cusparin, to which it is indebted for 
its tonic properties. At one time a serious fraud was committed on the 
continent of Europe, by substituting for it the bark of nux vomica, 
which was then termed false, spurious, or East India angostura, before 
its true character was known. It is now generally admitted by phar- 
macologists, that it must be referred to strychnos nux vomica. The 
characteristics of the true and the false barks are given in a tabular form 
by Dr. Pereira. 

Angustura bark is a valuable aromatic tonic ; but partly in conse- 
quence of its liability to adulteration with so poisonous an article as the 
bark of strychnos nux vomica, it has fallen into disuse. Moreover, it 
was found not to possess the febrifuge or antiperiodic virtues for which 
it had been extolled ; and it is now never used except as an aromatic 
bitter, in cases in which articles of the class are indicated. In very 
large doses, it is said to prove emetic and cathartic ; but it is never pre- 
scribed in this country with any other view than as a tonic, nor is it 
extensively used in that relation. Should it be desired to administer 
the powder, the ordinary dose is gr. x to ^ss ; but the most common 
and the best form of preparation is the following : — 

INFU'SUM ANGUSTFM, INFUSION OF ANGUSTU'RA BARK. {Angustur. cont. 
^ss ; Aq. bullient. Oj.) The dose of this infusion is f.liss to f.^ij. 

16. SERPENTA'RI A.— VIRGINIA SNAKEROOT. 

Virginia snake-root is the root of ^fbristolochia Serpentaria ; Sex. 



46 



SPECIAL TONICS. 



Syst. Gynandria Hexandria ; Nat. Ojrd. Aristolochiacese — an herba- 



131. 



ceous plant, flowering in May and 
June, and growing in rich shady 
woods throughout the Middle, 
Southern and Western states. It 
is collected in western Pennsyl- 
vania and Virginia ; in Ohio, In- 
diana and Kentucky ; is usually 
in bales, containing one hundred 
pounds ; and is often mixed with 
the leaves and stems of the plant, 
and with dirt from which it had 
not been well freed at the time 
when it was collected. The roots 
of Aristolochia hirsuta, A. has- 
tata, and Ji. reticulata, which 
scarcely differ from those of Ji. 
serpentaria, contribute indiscri- 
minately to furnish the snake- 
root of commerce ; although the 
last is the only one received as 
officinal. The root of aristolochia 
reticulata has been introduced of 
late, and is now not unfrequently 
used. It is derived from the west 
of the Mississippi ; and is com- 
posed of a knotty caudex, whence 
arise numerous long fibres, larger 
than those of the root of Aristolo- 
chia serpentaria. It has been an- 
alyzed by Mr. Thomas S. Wie- 
gand, of Philadelphia, who found 
the same constituents as in the officinal root, — the gum, extractive and 
volatile oil being in a somewhat greater proportion. 

Snakeroot, as met with in the shops, consists of the rootstock, whence 
proceeds a tuft oflong, slender, yellowish or brownish fibres. The colour 
of the powder is grayish ; the smell of the root aromatic and agreeable; 
and the taste warm and bitter. It yields its virtues to water and to alcohol. 
Its main active constituents are volatile oil, the odour and taste of which 
have been compared to that of valerian and camphor combined, — and 
bitter principle ; the former being the source of the aromatic and ex- 
citant, — the latter that of the tonic properties. 

Serpentaria has had great reputation as an excitant tonic; and, at one 
time, was employed to arrest intermittents ; but now that we possess 
more potent agents, it is rarely given except in association with those. 
It is much prescribed to support the powers in adynamic conditions of 
the frame. Should it be desired to exhibit it in powder, the dose may 
be from gr. x to Jss, and more ; but the following preparations are to be 
preferred. 




Aristolochia serpentaria. 



ARTEMISIA. 



47 



^ INFU'SUM SERPENTA'RUI, INFUSION OF VIRGINIA SNAKEROOT. (Serpentar. 
§ss ; Aquce bullient. Oj.) The dose is f.5iss to f.5ij. 

mCTFBA SERPENTA'RIJ, TINCTURE OF VIRGINIA SNAKEROOT. (Serpentar. 
contus. 3iij ; Alcohol, dilut. Oij ; prepared either by maceration or by 
displacement.) The tincture is rarely prescribed alone; but is added 
to tonic infusions, especially to the infusion of cinchona. The dose is 
f.Jj to f.3iij. 

Serpentaria forms part of the Tinctura cinchonce composita of the 
Pharmacopoeia of the United States. 



Fig. 132. 



17. ABSIN'THIUM.— WORMWOOD. 

The tops and leaves of Artemisia absinthium, common wormwood, 
are officinal in the Pharmacopoeia of the United 
States. The plant is indigenous in Europe, in 
the southern part of which it grows abun- 
dantly. It is also met with on roadsides and 
rubbish-heaps in Great Britain ; but the drug- 
gist is supplied with it from gardens near 
London. It is raised in the gardens of this 
country, and has been naturalized in the moun- 
tainous regions of New England. The plant 
is in flower in July or August, at which time 
the tops and leaves should be gathered. It 
has a penetrating, peculiar and disagreeable 
smell, and a very bitter, aromatic taste. It 
imparts its virtues to water and to alcohol. Its 
active constituents are volatile oil, which 
gives it its aromatic character; and bitter 
principle, on which its tonic virtues are de- 
pendent. 



Wormwood is a nauseous bitter, not now 
much employed, although it is adapted for 
cases in which the aromatic bitters are indi- 
cated. It is more used, perhaps, in atonic 
^ dyspepsia than in any other affection. Like 
all the simple and compound bitters, it was 
once much given in interraittents. 

Infusion is the best form of preparation. 
(Absinth. Zy, Aq. bullient. Oj. Dose; f.^iss 
to fjij.) The dose of the powder is 9j to 9ij. 




Artemisia absinthium. 



18. ARTEM'S'IA VULGA'RIS.— MUG WORT. 

All the species belonging to the genus Artemisia possess bitter and 
aromatic properties. Artemisia vulgaris, Sex. Syst. Syngenesia super- 
flua ; Nat. Ord. Compositse Corymbiferae, was, like the others, em- 



48 SPECIAL TONICS. 

ployed at one time as an aromatic tonic ; but it fell into disrepute, until 
revived in Germany in modern times as a remedy in epilepsy. It has 
not however, been much given as such in other countries of Europe, 
or in the United States. The root is the part employed, which should 
be dug up in autumn, after the stalk has become dry ; or in the spring 
before the stalk has shot up. Burdach recommends many precautions 
in its preparation. To remove epilepsy, he found it most efficacious, 
when given in the dose of a tea-spoonful — from fifty to seventy grains 

in warm beer ; about half an hour before the paroxysm. Should this 

be impracticable, it may be administered as soon as the patient can 
swallow. He must be put to bed immediately ; be covered up warm, 
and allowed warm small beer to drink, so as to occasion diaphoresis. 
This plan may be repeated according to circumstances. Burdach has 
entered into details on this subject, which the author has given else- 
where. (New Remedies, 5th edit. p. 94.) In general, it may be suffi- 
cient to prescribe a drachm of the powder three times a day, gradually 
increasing the dose ; or it may be given in infusion or decoction. (Arte- 
mis, vulg. rad. concis. 3j ; Aquae Oiss ; boil for half an hour. Dose, half 
a tea-cupful every two hours in cases of epilepsy.) 

It is to be feared that the assertions of the German physicians are too 
strong, and that the advantages to be derived from the artemisia in epi- 
lepsy have been exaggerated. Where there is no organic disease of the 
encephalon, substances, which, like the artemisia, are nauseous, bitter 
and aromatic, may be productive of advantage as tonics and revellents; 
and the author has seen one or two cases, in which beneficial effects 
have resulted from its use. It has likewise been given in other dis- 
eases, in which aromatic tonics are indicated, but it possesses no virtues 
over others of the class. 



Besides the aromatic bitter tonics, above described, the Pharmaco- 
poeia of the United States has the following in its secondary list. 

19. Angel'ica. — The root and herb of Angelica atro-purpurea, pur- 
ple angelica or masterwort ; Sex. Syst. Pentandria Digynia; Nat. Ord. 
UmbelliferaB, a plant which grows between Carolina and Canada, flow- 
ering in June and July. The plant has a strong smell, and an acrid 
and aromatic taste. It is used as an aromatic tonic, like Angelica Arch- 
angelica or garden angelica, of Europe. Its aromatic powers adapt it } 
for cases of atonic dyspepsia, and flatulent colic. The author has, how- 
ever, never seen it used. It may be given in infusion (Angelic. 5j ; 
Aq. bullient. Oj. Dose ; f.^iss to f.^iij.) 

20. As' arum, — Canada snakeroot, wild ginger. The root of Asarum 
Canadense ; Sex. Syst. Dodecandria Monogynia ; Nat. Ord. Aristolo- 
chiaceae ; which grows in old woods and shady places from Canada to 
Carolina, has an agreeably aromatic taste, considered to be intermediate 
between that of ginger and that of serpentaria ; qualities, which have 
given it the names of wild ginger, and snakeroot in different parts of the 
country. It has, also, been called CoWs foot. The properties seem to 



COTULA. 



49 



133. 




Dorstenia contrayerva. 



be dependent upon volatile oil, and a bitter resinous matter ; both of 
which are extracted by dilute alcohol. 
It resembles serpentaria in its proper- 
ties ; and is sometimes used as a substi- 
tute for ginger ; so that it might, with 
propriety, be classed amongst Exci- 
tants. 

21. Contrayer'va. — The root of 
Dorstenia Contrayerva; Sex. Syst. 
Tetrandia Monogynia ; Nat. Ord. Ur- 
ticacese — a native of Mexico, the West 
Indies, and certain parts of South Ame- 
rica—is imported chiefly from the West 
Indies, and the Brazils. Its odour is 
aromatic and peculiar ; taste warm, 
bitterish and slightly acrid. Its vir- 
tues appear to be dependent upon vola- 
tile oil, and bitter extractive. 

It is considered to resemble serpen- 
taria ; and has been prescribed in the 
same cases ; but it is rarely used in this 
country, or indeed any where. The 
dose of the powder is 9j to 3ss ; but it is best given in infusion (Con- 
trayerv. By, »%■ bul- 
lient.Oj. Dose, f Jiss.) 



22. Cot'ula, May- 
weed.— The herb *fln- 
themis Cotula, May- 
weed, wild chamomile, 
which grows abun- 
dantly both in the 
United States and Eu- 
rope ; flowering from 
the middle of summer 
till late in the autumn, 
has properties essen- 
tially the same as cha- 
momile; but its smell 
is so disagreeable, that 
it is rarely substituted 
for it. By the physi- 
cian, it is seldom or 
never prescribed. The 
flowers are less disa- 
greeable than the 
leaves, and may be 
given in infusion. 

Vol. II.— 4 




Antbemis Cotuta. 



50 



SPECIAL TONICS. 



Fig. 135. 




Magnolia Glauca 




Magnolia macrophylla. 



23. Eryn'gium, Button 
snakeroot. The root of 
Eryngium aquaticum, But- 
ton snakeroot or water 
Eryngo ; Sex. Syst. Pen- 
tandria Digynia ; Nat. Ord. 
Urnbelliferae, which grows 
in Virginia and Carolina, 
flowering in August, has a 

/ bitter, aromatic, pungent 
taste ; resembling, appa- 
rently, in its action, the or- 
dinary aromatic tonics. In 
large doses it is said to be 
emetic. The author knows 
/ nothing of its virtues from 
'/ his own experience ; nor is 
he acquainted with many 
who do. 

24. Magno'lia. This is 
the bark of Magnolia glau- 
ca, White Bay, Sweet Bay, 
Swamp Sassafras, Beaver 
tree ; — of M. acuminata, 

Cucumber tree, and of M. tripet- 
ala, Umbrella tree; Sex. Syst. 
Polyandiia Polygynia ; Nat. Ord. 
Magnoliaceae ; all of which are 
indigenous in the United States, 
and admired for the beauty of their 
i foliage, and the size and fragrance 
I of their flowers. The bark of the 
i root is considered to be most ac- 
Hffilj tive ; but that of the trunk and 
wMl branches is officinal also. It has a 
bitter, combined with a spicy, pun- 
gent taste. Dr. Stephen Procter, 
in an inaugural essay presented 
before Jefferson Medical College 
of Philadelphia, and published in 
the American Journal of Phar- 
macy for July, 1842, has given as 
the principal constituents of the 
bark of Magnolia Grandifiora, 
— green resin, volatile oil, (upon 
which its remedial virtues, he 
thinks, depend,) and a peculiar 
crystallizable principle resembling 
liriodendrin. The aromatic pro- 



GEUM. 51 

perty is impaired by drying, and wholly lost when the bark is long 
kept. 

Magnolia macrophylla — a native of the Southern, and some of the 
Western, States, and remarkable for the magnificence of its leaves and 
flowers — has similar remedial properties. 

Magnolia has been used in intermittents ; but it is not so now. It 
possesses the properties of the class in which it is placed ; and may be 
given as a gently excitant tonic. All its virtues are imparted to dilute 
alcohol. The infusion is less efficient ; but is a good tonic. The dose 
of the bark, in powder, is from 3ss to 3j- 

25. Marru'bium, Horehound. The herb of Marrubium vulgare, 
white horehound ; Sex. Syst. Didynamia Gymnospermia ; Nat. Ord. 
Labiatse, — which is indigenous in Great Britain, but grows in most 
parts of Europe and also in Asia and America ; flowering in July, — 
has a strong aromatic odour and a bitter taste ; the bitterness depend- 
ing upon extractive ; and the aromatic properties on volatile oil. Boil- 
ing water extracts its virtues ; and, hence, it is given in infusion (Marrub. 
S) ; Jiquce bullient. Oj. Dose, f.^iss to f.^iij) as a tonic ; but it has had 
more reputation as an excitant expectorant and emmenagogue. It 
enters into the composition of a candy — horehound candy — which is 
much used in catarrh. 

26. Matricaria, German Chamomile. This belongs to the same 
family as Anthemis or Chamomile ; and resembles it in all its properties. 
The flowers are smaller, less agreeable, and feebler ; but it may be pre- 
scribed in the same cases. 

27. Polyg'ala Rubel/la, Bitter Polygala. Both the root and herb 
of Poly gala Rubella, P. Polygama ; Sex. Syst. Diadelphia Octandria; 
Nat. Ord. Polygalese, — which is indigenous in many parts of the 
United States ; flowering in June and July, — are used. It is a strong 
and permanent bitter ; and has been esteemed tonic and excitant ; and 
in large doses diaphoretic, by virtue of its latter operation. It may be 
given in infusion or tincture. 

c. Astringent Bitter Tonics, 
which have an astringent associated with the bitter principle. 

28. GEUM.— WATER AVENS. 

This is the root of Geum rivale ; Sex. Syst. Icosandria Polygynia ; 
Nat. Ord. Rosacea? ; which is indigenous in the United States, and is 
in the secondary list of the Pharmacopoeia. It flourishes in Canada, 
and in the northern and middle States; sending forth its flowers in June 
and July. 

The root, as met with in the shops, is hard and readily reduced to 
powder ; is of a reddish or purplish colour ; devoid of smell ; and of 
an astringent and bitter taste. It has not been subjected to analysis ; 
but, doubtless, contains tannic acid and bitter principle on which its 
medical virtues are dependent. 

Water avens is tonic and astringent, and is, consequently, indicated 



52 



SPECIAL TONICS. 



u«« *.*h a ioint agency is needed, as in passive hemorhages, 
in cases where sucn a juim dgcuuj i* , r , 

and chronic d.schargcs. from, mucous mem bran es. »»•»£$££ 
atonic dyspepsia ; and in vanous ; .dynamo case* It may g 

for tea or coffee. 

29. PAULLIN'IA. 

This is an extract from a plant ^^^feijfc JJ 
prepared by the Induuft. J^^gtS^ Paulliri is prepared 

tfttS r d its active constituents 

appear to be tannic acid, ™*^.P n ^ mA give n as a tisane in 

In Brazil paulhnia is mixed with ^oa,^ 6 ^ France 

diarrhoea and dysentery; and it has been us^ ^^ ^ ^^ 

sis, convalescence from severe 
maladies, &c. According to 
Martius, an extract is prepared 
from Paullinia sorbilis, which is 
called there Guarana, and is 
used in similar morbid cases. 



The secondary list of the 
Pharmacopoeia of the United 
States contains the following 
articles, which may also be re- 
ferred to this division of simple 
tonics. 

30. Hepat'ica, Liverwort;-^ 
the leaves of Hepatica America- 
na, an indigenous plant. They 
have no aroma; their taste is 
mucilaginous, somewhat astrin- 
gent, and slightly bitter; and 
they possess no other properties 
than those of a demulcent tonic, 
notwithstanding the clamour 
that prevailed in their favour, 
in this country, some years ago, 
as a valuable remedy in chronic 
bronchitis, haemoptysis, &c. In- 
fusion is the best form of admin- 
istration. {Hepatic. §j ; Aq. 
bullient. Oj. Dose, f.5iss to 
*^iij.) 




Hepatica Americana. 



31. Prinos, Black Alder. This is the bark of Prinos verticillatus. 



INDIGUM. 53 

Black M(kr ; Sex. Syst. Hexandria Monogynia; Nat. Ord. Illicineae, 
(Lindley)— Rharani, (Jussieu) ; an indigenous shrub, which grows every 
where in the United States ; flowering in June. The dried bark is 
inodorous ; its taste bitter and slightly astringent. It imparts its virtues 
to boiling water. 

Black alder has long been used as a popular remedy in intermittents ; 
and in other affections, as a substitute for cinchona. It is rarely, how- 
ever, prescribed by the physician. The dose of the powder may be 
stated at from Jss to 5j« It may, also, be given in infusion, (Prin. 3j ; 
Jlqux bullient. Oj) ; decoction and tincture. The berries have similar 
properties with the bark, and are sometimes made into tincture. 



d. Mechanical Tonics, 

or such as seem to act mechanically. 

32. CARBO LIGNL— CHARCOAL. 

It is obtained by burning wood in such manner as to exclude the 
access of atmospheric air. It is black, devoid of odour and taste, 
having the texture of the wood from which it has been obtained. It 
is easily reduced to powder, and is insoluble. When perfectly dry, 
it absorbs many times its own bulk of certain gases ; abstracts from 
liquids, in which they are dissolved or diffused, different colouring and 
odorous matters ; and hence is used as an antiseptic, and also — although 
to a less extent than animal charcoal — to deprive liquids of their colours. 

Charcoal has been administered occasionally in intermittent fever, 
and has succeeded, — not probably in consequence of its possessing 
any intrinsic medical virtues, — for it would seem to have none, — but 
owing to the impression made on the stomach by the insoluble woody 
matter. It is, also, used as a tonic in dyspepsia ; and, when combined 
with magnesia, is well adapted for cases in which there is redundant 
secretion of the gastric acids, and constipation. Probably, as a tonic, 
its action is mechanical, "by the new impression it occasions on the lining 
membrane of the stomach and intestines, exciting the chylopoietic organs 
to increased activity. In the same manner it proves cathartic in large 
doses. In addition to this tonic action, — by virtue of its antiseptic 
properties it corrects nidorous eructations, and the fetid secretions, 
often evacuated in diarrhoea and dysentery. 

The dose of charcoal is from gr. x to Jss, or more. Ten to fifteen 
grains, united with ten of magnesia or carbonate of magnesia, may be 
given in the cases above mentioned, and be repeated two or three 
times a day, should the case require it. 



. 33. IN'DIGUM.— IN'DIGO. 

The well known colouring material Indigo is obtained by fermenta- 
tion from several species of the genus Indigofera, — I. tindoria, I. anil, 
I. disperma, I. argentea, and J. hirsuta; Sex. Syst. Diadelphia Decan- 




54 SPECIAL TONICS. 

dria ; Nat. Ord. Leguminosse. During the fermentation, the indigo — 
which is an educt of the process — is deposited as 
Fig. 138. a feculent matter. It is chiefly brought from the 

East Indies ; but a considerable quantity is de- 
rived from Guatemala and other places. As we 
receive it, it is generally in small, solid, brittle 
masses, of a deep azure colour, without smell or 
taste, and assuming a copper colour on being 
rubbed. 

Indigo has been prescribed in various spasmo- 
dic diseases, and especially in epilepsy; and 
many individuals have deposed to the services it 
mdigoferatinctoria. " has rendered. Others, however, have not testi- 
fied so favourably. Trials, made with it at the 
Philadelphia Hospital, were favourable ; but others were not at all so. 
The results are detailed in another work. (New Remedies, 5th edit. p. 
370, Philad. 1846.) It is obvious, however, as there stated, that a 
wide difference must exist amongst cases of epilepsy ; and that where 
the organic modifications are considerable, little can be expected from 
any remedy ; but even in such hopeless cases, the number of paroxysms 
would seem to have diminished under its use. Where the cerebral 
affection is slight, and more functional than organic, indigo — like arte* 
misia, and some other remedies extolled in epilepsy — may be useful. 
It certainly, — from the doses in which it may be administered, — ap- 
pears to be nearly inert, and perhaps its main efficacy, as the author has 
said of Ferri subcarbonas, consists in the new impression, which it 
makes, in adequate doses, upon the nerves of the stomach ; and through 
them upon those of the whole system; but to effect the revulsion to the 
necessary extent, it is important that the dose should be augmented 
day by day ; and the remedy be continued, in large doses, for a suffi- 
cient length of time. 

It may be begun with in the dose of Jj ; and this may be doubled 
daily, until the patient takes gij in the day, which may be continued for 
weeks. As the powder is very light, it has been proposed to give it in 
the form of electuary, with simple syrup as the constituent. Some aro- 
matic — as Pulvis aromaticus— may be added to it, to prevent it from 
exciting nausea, which it probably does from quantity only. 

e. Mineral Tonics. 

r 

FERRI SALES,— SALTS OF IRON. 

The effects of the preparations of iron— commonly called Chalybeates 
and Ferruginous or Martial preparations — are known to all profes- 
sional and lay. They are, in proper doses, tonic ; and but few'of them 
are poisonous in any dose. They vary, however, in their precise action 
on the economy, some possessing, along with a tonic power, decided 
astringency ; so that they may not be adapted for certain cases in which 
others of the class may be. In many cases in which they are prescribed 
—as in the neuroses— their operation seems to place them decidedly 



FERRI SUBCARBONAS. 55 

under the class of tonics ; but in others, where great impoverishment of 
the blood has taken place, as in different forms of anaemia, and in the 
defective and perverted nutrition thereon dependent, their action would 
seem to be on the blood itself, and through it on the tissues ; hence 
they fall properly under the class Eutrophics. Such would be their 
action in cancer. It has been supposed, indeed, that certain cachexia? 
are connected with a deficiency of iron in the system, which the use of 
chalybeates is well adapted to supply. 

Of the use of iron as an emmenagogue, the author has spoken else- 
where, (vol. i. p. 413). He has there endeavoured to show, that its 
operation is altogether indirect ; and that as amenorrhcea is most com- 
monly connected with an asthenic condition of the system in general, 
and of the uterus in particular, chalybeates become proper remedies. 

In certain of the neuroses, they have been found serviceable, — 
especially in chorea and neuralgia ; and in the latter disease, one of the 
preparations has been more successful than any other remedy perhaps ; 
yet in all such cases — indeed in all cases — their use has to be persevered 
in for a length of time. 

Although none of the preparations of iron are now used as antiperi- 
odic tonics, they have been. They are still prescribed in the sequelae 
of intermittents, and have exhibited valuable properties in the disper- 
sion of enlargements of the spleen, which are generally, however, easily 
removed by the sulphate of quinia. M. Cruveilhier affirms, that by 
the aid of iron he has obtained the resolution of enlargements which 
have occupied half, or even two-thirds, of the abdomen. 

The general properties of the chalybeates adapt them, consequently, 
for asthenic conditions of various organs, and of the system generally ; 
and some — it will be seen — are possessed of astringent powers which 
adapt them for chronic diarrhoea and dysentery. The special cases, 
however, that require their use, will be readily appreciated by an exam- 
ination of their individual properties. 

34. FERRI SUBCAR'BONAS — STJBCAR'BONATE OF IRON. 

This preparation, called also Sesquioxide of Iron, red Oxide of Iron, 
and Carbonate of Iron, is obtained by mixing solutions of sulphate of 
iron and carbonate of soda together ; stirring the mixture, and setting it 
by, that the precipitate may subside ; which is then washed with hot 
water and dried. 

When the two solutions are mixed together, the sulphuric acid of the 
sulphate of iron lays hold of the soda of the carbonate of soda, whilst 
the carbonic acid of the latter lays hold of the oxide of iron of the 
former. We thus have carbonate of protoxide of iron ; but, in the 
process of drying, the protoxide attracts oxygen from the air, and car- 
bonic acid is disengaged, so that there ultimately remains sesquioxide 
of iron, with a trace of carbonic acid. 

Subcarbonate of iron is a rust-coloured powder, possessing a decided 
chalybeate taste. It is sometimes adulterated with brick-dust, which is 
detected by exposing it to the action of dilute chlorohydrk acid. This 
dissolves the whole of the subcarbonate ; and leaves the impurities. 



56 SPECIAL TONICS. 

The subcarbonate is one of the preparations of iron most used, and 
is adapted for most cases in which chalybeates in general are needed. 
It was much employed by Mr. Carmichael as a remedy in cancer ; but 
although the cachectic condition has appeared to be occasionally bene- 
fitted by it, the results have not been encouraging. 

In neuralgia, and especially in neuralgia faciei, it was introduced, 
many years ago, to the notice of the profession, by Dr. Benjamin Hutch- 
inson, who published numerous successful cases of its employment; 
and, since that time, many testimonials have been adduced in its favour. 
In the author's hands, in one or two inveterate cases, it has proved sig- 
nally successful. The novelty of Dr. Hutchinson's plan was to give it 
in very large doses; — 3y> an< ^ even Jss and more, in the course of 
twenty-four hours. Should it disagree with the stomach, an aromatic 
may be added — for example, five grains of ginger powder, or of Pulvis 
aromaticus, to each dose. If signs of polysemia or hypereemia exist, 
they should be first removed; and, should they supervene on its em- 
ployment, antiphlogistics may be needed, and the subcarbonate be 
resumed after their removal. It may, likewise, be necessary to give a 
brisk cathartic occasionally. 

The ordinary dose of subcarbonate of iron, as a tonic, is from gr. v 
to gr. xx, twice or thrice a day, in honey or molasses. 

Subcarbonate of iron is used in the preparation of Ferri et potassa 
tartras, and Tinctura ferri chloridi, of the Pharmacopoeia of the United 
States. 

35. FERRI OX'IDUM HYDRA'TUM HY'DRATED OXIDE OF IRON. 

This preparation — called also Hydrated sesquioxide of Iron, Hydrated 
peroxide of Iron, Hydrated tritoxide of Iron, Ferrugo — has been intro- 
duced, within the last few years, as an antidote to arsenic. It is pre- 
pared by converting common green vitriol, or sulphate of protoxide of 
iron, into sulphate of the sesquioxide by means of nitric acid, aided by 
heat. The nitric acid is decomposed ; nitric oxide gas is disengaged ; 
and part of the oxygen of the decomposed nitric acid unites with the 
protoxide of iron to convert it into sesquioxide. As, however, there is 
too little sulphuric acid in the sulphate of the protoxide to keep the 
iron in solution when it becomes sesquioxide, sufficient sulphuric acid 
is added to form the sulphate of the sesquioxide, — namely, half the 
amount of acid contained in the sulphate of iron employed. Solution 
of ammonia is then added in excess to decompose the sulphate of the 
sesquioxide, by uniting with the sulphuric acid of the sulphate. The 
precipitated sesquioxide is washed with water, until the washings cease 
to yield a precipitate with chloride of barium ; or, in other words, are 
freed from sulphuric acid ; and the sesquioxide is kept in close bottles 
with water sufficient to cover it. 

This oxide is of a reddish or yellowish brown colour ; and is much 
more readily dissolved in dilute acids than the anhydrous sesquioxide. 
It is wholly soluble in chlorohydric acid without effervescence. 



FERRUM AMMONIATUM. 57 

Hydrated oxide of iron is possessed of the same properties as the 
subcarbonate or anhydrous sesquioxide, and might be given in the same 
cases. Dr. Christison considers, that it must be preferable from its su- 
perior solubility. The evidence in favour of its action as an antidote to 
arsenic, has been given at length elsewhere. (New Remedies, 5th edit, 
p. 314, Philad. 1846.) It would appear to render the poison insoluble, 
and would seem to be worthy the reliance of the practitioner. It must 
be administered, however, in very large doses — a table-spoonful every 
five or ten minutes, or as often as the patient can swallow it. For ordi- 
nary cases, as a chalybeate, the dose may be the same as that of the 
sesquioxide or subcarbonate. 

36. FERRI CHLCRIDUM— CHLORIDE OF IRON. 

The only officinal form, in which the chloride, sesquichloride or mu- 
riate of iron, is used is that of 

TINCTU'RA FERRI CHLO'RIM, TINCTURE OF CHLORIDE OF IRON, Tincture of 
Muriate of Iron, Solution, of Muriate of Iron. (Ferri subcarb. ggss; 
Acid, muriat. Oj ; Alcohol. Oiij.) Subcarbonate or sesquioxide of iron 
dissolves in chlorohydric or muriatic acid with slight effervescence ; and 
the sesquichloride of iron results; so that the tincture is really a tincture 
of sesquichloride of iron, and is so named in the London Pharma- 
copoeia. 

The tincture is of a reddish brown colour; has a sour styptic taste, 
from excess of muriatic acid ; and an odour of chlorohydric ether, 
which exists in it in small quantity, owing to the action of the chloro- 
hydric acid on the alcohol. This excess of acid is necessary for keep- 
ing the protochloride of iron— of which there is a small portion in the 
tincture — in solution ; as the protoxide of the protochloride, when the 
ticture is exposed to the air, is converted into sesquioxide ; and a part 
is deposited. 

Tincture of chloride of iron possesses the general properties of the 
chalybeates, and is extensively prescribed in asthenic affections. Its 
virtues as an astringent are referred to elsewhere. The dose is from 
ntx to n^xxx, gradually increased to f.5i or f.3ij» two or three times a 
day, in water. 

The solution of pernitrate of iron possesses analogous properties ; 
but it is almost wholly prescribed as an astringent. 

37. FERRUM AMMONIA'TUM.— AMMOWIATED IRON. 

In the preparation of Ammoniuret of Iron, Ammoniated Chloride of 
Iron, Ammonio-chloride of Iron, according to the processes of the Phar- 
macopoeias of London and the United States, — subcarbonate of sesqui- 
oxide of iron is dissolved in muriatic acid, by which means a sesqui- 
chloride is obtained. A solution of muriate of ammonia, of definite 
strength, is then added ; and the filtered liquor is evaporated to dryness. 
The residue is rubbed to powder, which appears to consist of the two 



58 SPECIAL TONICS. 

c/jiorohyd rates or muriates, as, notwithstanding the nomenclature of 
the London College, no chemical combination seems to take place 
between them. 

Ammoniated iron is a yellow powder, which is deliquescent, and 
soluble both in water and alcohol. 

The quantity of iron in ferrum ammoniatum is much less than in 
most of the other preparations of iron, and it is by no means the same 
in all cases. On this account, although it was at one time used exten- 
sively in asthenic cases, and especially in some of the neuroses— as 
epilepsy and chorea— it is now rarely employed. The dose is from gr. 
iv to gr. xii, or more, in pill ; or in solution. Astringent vegetable 
substances decompose it. 

38. FERRI ET POTAS'SiE TARTRAS.— TARTRATE OF IRON AND POTAS'SA. 

Tartrate ofPotassa and Iron, Ferro-tartrate of Potassa, Ferric tartrate 
of Potassa, or Potassiotart 'rate of Iron, according to the Pharmacopoeias 
of London and the United States, is made by dissolving subcarbonate 
or sesquioxide of iron in muriatic acid, so as to form a sesquichloride; 
throwing down the hydrated sesquioxide by caustic potassa ; and digest- 
ing this in a solution of bitartrate of potassa, so that the excess of acid 
in the bitartrate may be neutralized by the sesquioxide. This is digested 
for some time at a moderate heat ; and, afterwards, the solution is 
filtered, and evaporated to dryness. 

Tartrate of iron and potassa is an olive-brown powder ; and has a 
ferruginous taste. It is slightly deliquescent, — perhaps from the tar- 
trate of potassa it contains, — and is wholly soluble in water. It is 
slightly soluble in alcohol. The solution in water is not liable to de- 
composition for a considerable period. 

In commerce, an imperfectly prepared compound is frequently met 
with, in which none, or only part, of the sesquioxide of iron is in 
chemical combination with bitartrate of potassa. The following are 
the characters of the salt, when properly prepared according to the pro- 
cess of the Pharmacopoeia "of the United States : " Tartrate of iron and 
potassa is wholly soluble in water. Its solution does not change the 
colour of litmus; and at common temperatures does not yield a pre- 
cipitate with potassa, soda, or ammonia. Ferrocyanuret of potassium 
does not render it blue unless an acid be added." 

Tartrate of potassa and iron has all the virtues of the chalybeates, 
but in a much milder degree. Its taste is, however, more agreeable, 
and its solubility ready ; so that it affords a pleasant chalybelfe in dis- 
eases of childhood. The dose is from ten grains to half a drachm. % 

39. FERRI FERROCYANURE'TUM— FERROCYAN'URET OF IRON, PURE PRUS'- 

felA^i BLUE. 

Ferrocyanuret of Iron, Ferrocyanate of Iron, Percyanide of Iron 
Ferro-sesquicyanide of Iron, Cyanuret of Iron, is prepared on the large 



FERRI FERROCYANURETUM. 



59 



scale for purposes of the arts ; and was, therefore, comprised in the 
materia medica list of the first Pharmacopoeia of the United States. In 
the last revision, however, a preparation is given for a pure article, 
such as is well adapted for medicinal administration. It is prepared, 
as an article of commerce, by fusing animal matters with carbonate of 
potassa, so as to form cyanuret of potassium ; and treating the solution 
of the product with sulphate of alumina and potassa, and sulphate of 
iron. The greenish precipitate, formed in this manner, acquires, under 
exposure to the air, a beautiful blue colour. In this state, ferrocyanuret 
of iron is impure ; — containing alumina, sesquioxide of iron, and ferro- 
cyanuret of potassium. To purify it, it is digested in diluted sulphuric 
acid. 

The pure article of the United States Pharmacopoeia is formed by the 
reaction of ferrocyanuret of potassium on sulphate of sesquioxide of 
iron, washing the precipitate with boiling water, until the washings 
pass tasteless ; then drying the precipitate, and rubbing it into powder. 

Pure Prussian blue is of a rich dark blue colour ; without smell or 
taste ; and it has been regarded as devoid of action on the animal 
economy. It is certainly questionable, whether it exert any more influ- 
ence than indigo. It is insoluble in water and alcohol ; and when 
broken has a bronzed tint, resembling that of indigo, but distinguish- 
able from it by being removed when rubbed with the nail. The test of 
its purity— as given in the London and United States Pharmacopoeias 
— is, that if it be boiled with dilute chlorohydric acid, and ammonia 
be added to the filtered liquor, no precipitate is produced. As ordinary 
Prussian blue contains alumina and sesquioxide of iron, by boiling the 
article in chlorohydric acid, both substances will be dissolved, and am- 
monia be thrown down. 

Although ferrocyanuret of iron appears to exert no influence on man 
or animals in health, it has been regarded not only as a simple, but as 
an antiperiodic tonic. It has, accordingly, been given in atonic condi- 
tions in general, especially of the intestinal canal ; but, like indigo, it 
has been more extolled in epilepsy and chorea; and has been prescribed 
in intermittent fever, on the recommendation of Dr. ZollickofTer, of 
Maryland, and others. It has likewise been found of service in facial 
neuralgia ; and in some cases of scrophulosis. The author has given 
it in all these cases, but has not been satisfied with its effects. Dr. Zol- 
lickofTer considers it to be especially adapted for intermittents and remit- 
tents occurring in children, on account of the smallness of the dose 
required, and its want of taste. The detailed evidences, adduced in its 
favour, are given in another work, (New Remedies, 5th edit. p. 295, 
Philad.1846). 

It has been used in the form of ointment, (Ferri Ferrocyanuret. 3j ; 
Ung. cetacei 3j ;) to ill conditioned, torpid, and foul ulcers. 

The dose is five grains, three or four times a day, gradually. increased. 

Ferrocyanuret of iron is used in the preparation of Hydrargyri Cy- 
anuretum, of the Pharmacopoeia of the United States. 



60 



SPECIAL TONICS, 



40. FERRI PHOSPHAS.— PHOSPHATE OF IRON. 

Phosphate of Iron — which is peculiar to the United States' Pharma- 
copoeia — is formed by the double decomposition of Sulphate of Iron and 
Phosphate of Soda: the sulphuric acid of the sulphate of iron lays hold 
of the soda of the phosphate of soda ; and the resulting sulphate of 
soda remains in solution, whilst the phosphoric acid of the phosphate 
of soda combines with the protoxide of iron of the sulphate of iron, and 
forms phosphate of iron, which is precipitated. It is of a slate colour, 
and is insoluble in water. It possesses the general virtues of the chaly- 
beates ; but, like many others of the preparations of iron, does not 
appear to possess any special virtues to occasion its retention as an offi- 
cinal preparation. The dose is from gr. v to gr. x. It is, however, 
but little used. The cause of its admission into the United States 
Pharmacopoeia is stated to have been " the suggestion of Dr. Hewson, 
of Philadelphia, who found it, after an extensive experience, to be a 
valuable chalybeate." (Wood & Bache.) 

41. FERRI SULPHAS.— SULPHATE OF IRON. 

Commercial sulphate of iron, commonly called Green Vitriol or Cop- 
peras, is usually prepared on a very extensive scale by exposing iron 
pyrites to the air for several months ; moistening it either by rain or arti- 
ficially ; and so arranging the bed on which the pyrites is placed, that 
the water may run into a reservoir, whence it can be withdrawn, to be 
evaporated for obtaining the sulphate of iron formed. Iron pyrites is a 
native sulphuret of iron ; and, by the above treatment, the pyrites 
attracts oxygen, and becomes converted into sulphate of protoxide of 
iron. This is too impure, however, for medicinal use; and, accordingly, 
the London and United States' Pharmacopoeias direct it to be made by 
the action of dilute sulphuric acid on iron wire or iron filings. When 
thus prepared, the crystals are transparent, and of a bluish-green colour, 
but on exposure to air, they effloresce, absorb oxygen, and change 
colour, by the formation of sulphate of sesquioxide of iron. It is very 
soluble in water, but insoluble in alcohol, and iron does not produce 
with its solution a precipitate of copper. It has a strong inky, astrin- 
gent taste, and reddens litmus. 

Sulphate of Iron is a powerful chalybeate, possessing, at the same 
time, astringent properties ; and, as will be seen hereafter, employed in 
many cases on account of these. In very large doses, it acts as an irri- 
tant to the stomach and bowels, occasioning nausea, gastrodyjiia and 
vomiting ; yet it can scarcely be ranked as a poison. As a tonic, it is 
given in all cases in which chalybeates are indicated. By some, indeed, 
it is regarded as probably one of the best, as it is the most uniform, of 
the preparations of iron. The dose is from one to five grains in the 
form of pill. 

Sulphate of Iron enters into the formation of Ferri Ferrocyanuretum 



FERRI PROTOCARBONAS. 61 

Ferri Oxidum hydralum, Ferri Phosphas, Ferri Subcarbonas, Mistura 
Ferri Composita, and Pilulce Ferri Composite, of the Pharmacopoeia of 
the United States. * 



42. FERRI PROTOCAR'BONAS.— PROTOCAR'BONATE OF IRON. 

When protocarbonate of iron is thrown down from sulphate of iron 
by carbonate of soda, it readily absorbs oxygen ; carbonic acid is given 
off; and the protocarbonate becomes converted into sesquioxide of iron. 
It has been long desired, that some mode should de discovered, by 
which the salt could be maintained in a state of protocarbonate. The 
addition of sugar was found to effect this object in a great degree, check- 
ing the oxidation of the iron, but not wholly preventing it. Accord- 
ingly, a preparation has been introduced into the Edinburgh Pharma- 
copoeia under the name Ferri Carbonas Saccharatum, in which the 
precipitated protocarbonate, obtained by the decomposition above men- 
tioned, is triturated with sugar, and dried at a temperature not much 
exceeding 120°. The powder, thus obtained, is considered to be car- 
bonate of protoxide of iron in an undetermined state of combination 
with sugar ; and sesquioxide of iron. It is of a grayish green colour, 
and is readily soluble in chlorohydric acid with brisk effervescence. 

Protocarbonate of iron has been highly extolled in cases in which the 
chalybeates in general are indicated. It is readily soluble in acids, and 
in the fluids of the stomach ; and is, therefore, easily absorbed. In 
the dose of fifteen grains it has produced, in the experience of some, 
nausea, headache, and a sense of fulness in the head ; whilst subcar- 
bonate of iron or sesquioxide is often given in very large quantities, 
without any such results. The author has not, however, observed these 
in a single instance. Its dose is from gr. v to 3ss, two or three times 
a day. 

PILULE FERRI CARBOM'TIS, PILLS OF CARBONATE OF IRON. VALLET'S 
FERRUGINOUS PILLS. These have been introduced into the last edition of 
the Pharmacopoeia of the United States, (1842). They are formed of 
sulphate of iron, carbonate of soda, clarified honey, syrup, and boiling 
water ; the process being essentially that for the formation of protocar- 
bonate of iron, — the mixture, after the addition of honey, being subjected 
to heat, until it attains a pilular consistence. 

These pills have been prescribed in most of the diseases in which 
chalybeates in general are considered to be indicated ; and especially 
in chlorosis and amenorrhcea. The author has given them freely, but 
has had no reason for assigning them any pre-eminence over the other 
preparations of the metal. The objection, urged against the preparation 
to be next described, is, that the protocarbonate becomes converted into 
sesquioxide, but it remains to be proved whether the objection have 
any force. It has, indeed, been unhesitatingly affirmed by M. Blaud, 
that it has not. 

The dose of the pills — weighing three grains each, and therefore con- 



62 



SPECIAL TONICS. 



taining less than a grain and a half of the protacarbonate — is eight or 
ten daily. 

Mr. Donovan advises that protocarbonate of iron should be prepared 
in the following manner for extemporaneous use. Blue sulphate of iron, 
in fine powder, 5ss ; Calcined magnesia 9ij ; Water f.Ivi ; Tincture oj 
quassia f.3ij. Divide into six draughts. One to be given night and 
morning. 

MISTU'RA FERRI COMPOS'ITA, COMPOUND MIXTURE OF IRON. This mixture 
was suggested by a preparation, which was long known as Grif- 
fiths Mixture, from the name of the physician who introduced it into 
notice ; and it still bears the appellation with many. It is composed as 
follows : — Myrrh. 3j ; Potasses, carbonat. gr. xxv ; Jlquce rosce fjviis 
Ferri sulph. in pulv. 9j ; Sp. lavandul. f.§ss ; Sacchar. 3j. This mix- 
ture, when recently prepared, is a solution of protocarbonate of iron ; 
but when exposed to air, it attracts oxygen ; parts with carbonic acid ; 
and deposits sesquioxide of iron. It has been long celebrated as a 
tonic, and especially in cases of amenorrhcea, — the myrrh and spirit of 
lavender being added on account of their reputed emmenagogue virtues. 
It has likewise been largely prescribed in anaemia, chlorosis, and ner- 
vous affections in general. It is not easy to see on what grounds it has 
been so often given in the hectic of phthisis ; and in chronic catarrh. 
In such cases, it certainly possesses no virtues over other admixtures of 
tonics and excitants. 

The ordinary dose of the mixture is f.^i to f.§ij, two or three times a 
day. 

PILULE FERRI COMPOSITE, COMPOUND PILLS OF IRON. {Myrrh, pulv. 3ij ; 
Sodce carbonat, Ferri sulph. aa 3j ; Syrup, q. s. Make into 80 pills.) 
These pills, called also Griffith's Pills, resemble the last preparation 
in the circumstance that the same kind of double decomposition takes 
place ; so that, if it be desired to administer the protocarbonate, they 
should be prepared extemporaneously, and not kept in the shops. The 
dose is from two to six pills, two or three times a day. 

A medicine, which resembles Pilulse Ferri Composite^ has lately 
acquired great celebrity in the south of France. It is called, from its 
inventor, BlauoVs Pills. In it, carbonate of potassa, or the bicarbonate, 
is used instead of carbonate of soda. The objection made to these 
pills— as in the case of Mistura Ferri Composita, and Pilulse Ferri Com- 
posita?— is, that the protocarbonate of iron becomes converted into ses- 
quioxide ; but M. Blaud properly asks—" What signifies it to practitioners 
that my pills contain little or no protoxide of iron, provided they cure 
chlorosis :" and in testimony that they do so, he adduces a long list of 
cases in which a cure was obtained in three or four weeks. These pills 
M. Blaud calls his " antichlor otic pills." 

43. FERRI IOD'IDUM.— I'ODIDE OF IRON. 

lodidt, Protiodide, loduret, Hydriodate or Iodohydrate of Iron is 



FERRI IODIDUM. 63 

made by gradually adding iron filings to a mixture of iodine and 
water. Heat is then applied, through the intervention of which a union 
takes place between the iodine and the iron, which is denoted by the 
liquid assuming a greenish colour. By evaporation to dryness, the 
iodide is obtained ; which must be kept in a closely stopped bottle. It 
is of an iron-gray colour ; foliated texture ; brittle, and exhibits a crys- 
talline arrangement similar to metallic antimony, except that it is darker. 
In the dry state, it is devoid of smell ; but when moist it exhales an 
odour of iodine : when dry, it has a strong styptic chalybeate taste ; and 
when moist, an acrid taste precedes the other. It dissolves, in all pro- 
portions, in water ; making a greenish solution ; and, by exposure to 
air, forms, by the absorption of oxygen, sesquioxide and sesquiiodide 
of iron ; the former of which is insoluble ; the latter soluble. To pre- 
vent these changes a coil of soft iron wire should be kept immersed in 
it. The iodide is decomposed by heat, with the disengagement of violet 
vapours, and the production of sesquioxide of iron 

Iodide of iron has been frequently given by the author, in public and 
in private practice ; and he has considered it especially adapted for 
cases in which there appears to be torpor in the system of nutrition, — 
as in asthenic dropsy, old visceral engorgements, and indeed, in hyper- 
trophy of any kind, accompanied by deficient action in the intermediate 
system of vessels. In anaemia or oligaemia, where there is paucity of 
red globules in the blood ; and the fluid is altogether too thin, it would 
seem to be especially indicated, from the property which it possesses of 
promoting the coagulation of the blood, and therefore of inspissating 
it. It appears, indeed, to be the best remedy we possess whenever a 
eutrophic and tonic is indicated. It has been given with advantage, as 
a tonic, in chlorosis; in atonic amenorrhcea ; atonic dyspepsia; and, 
indeed, in all cases that are accompanied by debility. In such affec- 
tions, Dr. A. T. Thomson conceives the iodide to act more efficiently 
than any of the other preparations of iron. In atonic gastric dyspepsia, 
the same gentleman found it serviceable, when combined with bicar- 
bonate of potassa, taken at the moment of admixture, in the dose of 
three to eight grains or more. In chorea, it has been considered by Dr. 
C. J. B. Williams to answer better than any other chalybeate. 

The dose of the iodide is three or four grains two or three times a day. 
It may be given in the form of Pills of Iodide of Iron, which may be 
prepared in the following manner, after a formula communicated by Mr. 
Robert Leslie, of Glasgow, to Dr. Christison. Take of Iodine, 127 
grains ; iron wire, of about the thickness of a thin quill, half an ounce ; 
distilled water, 75 minims. Agitate them briskly together in a strong 
ounce phial, provided with a well-fitted glass stopper, until the froth, 
which forms, becomes white. This will happen in less than ten minutes. 
Pour the liquid upon two drachms of finely powdered loaf sugar in a 
little water, and triturate immediately and briskly for a few minutes ; 
add gradually a mixture of the following powders, viz. liquorice pow- 
der, half an ounce; powder of gum arabic, a drachm and a h?\£; flour, 
one drachm : divide the mass into 144 pills. Each pill will contain 
about a grain of iodide of iron. 



64 SPECIAL TONICS. 

LIQUOR FERRI IOD'IDI, SOLUTION OF IODIDE OF IRON. The preparation 
of this name, introduced into the last edition of the Pharmacopoeia of 
the United States, (1842,) is founded on the principle, that to protect 
the solution of the iodide from decomposition, it is advisable to asso- 
ciate it with sugar or honey ; which appears to exert the same protective 
agency as it does on the protocarbonate of iron. The solution is made 
after a form proposed by Mr. Procter, of Philadelphia. The first steps 
of the process, until the liquor assumes a light greenish colour, are the 
same as for the preparation of Iodide of Iron ; honey is then added, and 
distilled water to make the quantity of solution required. 

The dose of the officinal solution is ten drops, three times a day. 
The tests of its purity, according to the Pharmacopoeia of the United 
States, are, that it is " of a pale greenish colour ; but on the addition 
, of sulphuric acid becomes brown, and emits violet vapours, if heated. 
It has little or no sediment, and does not communicate a blue colour to 
starch." 

Syrup of iodide of iron, prepared in an analogous manner, is directed 
in the Edinburgh Pharmacopoeia. 

44. FERRI LACTAP.— LACTATE OF IRON, j 

This preparation has only been introduced of late years into medicine. 
It is formed by treating pure iron flings with lactic acid diluted with 
water. It is in the form of crystalline plates, very white, and changing 
but little in the air. It is sparingly soluble in water; reddens litmus 
paper ; and possesses the ferruginous taste in a tolerable degree. 
When dissolved in water, it attracts oxygen, and quickly becomes 
yellow. 

Lactate of iron has been prescribed in cases in which the protocar- 
bonate is employed, and chiefly in chlorosis. MM. Gelis and Conte 
are, indeed, disposed to refer the beneficial effects of the latter to its 
becoming lactate of iron in the stomach, by uniting with the lactic acid, 
which, they think, is one of the gastric acids. This idea led them to 
administer lactate of iron ready formed. It would seem, however, that 
in health there is no lactic acid in the stomach. The testimonials in 
favour of its good effects in chlorosis, and wherever chalybeates are sug- 
gested, are numerous. Messrs. Mialhe and Pereira, however, think- 
there is no evidence of its superiority over citrate of iron ; and such 
is the opinion of the author. 

45. FERRI CITRAS.— CITRATE OF IRON. 

Two citrates of iron were introduced some years ago, by M. Beral 

the citrate of the sesquioxide of iron, per citrate of iron, and the citrate 
of the protoxide, protocitrate of iron ; the former of which is chiefly 
used. It is formed by treating hydrated oxide of iron with citric acid 
dissolved in water. It is in thin pieces, of a beautiful garnet-red 
colour ; dissolves slowly in cold water, but readily in boiling water, or 



FERRI FILUM. 65 

in cold when a few drops of liquor ammoniae are added, which convert 
it into ammonio- citrate. 

Citrate of Iron greatly resembles the tartrate and the lactate in its 
properties. It is an elegant chalybeate ; and has been much and satis- 
factorily prescribed by the author, where chalvbeates in general have 
been indicated. The dose is from five grains to twenty ; either in pill 
or solution. 

Ammonio-citrate of Iron, Ferric citrate of ammonia is prepared by 
neutralizing the excess of acid in preparing the citrate of the sesqui- 
oxide by ammonia, and evaporating. It is a much more soluble salt 
than the citrate of the sesquioxide, and is slightly deliquescent. If the 
acid of the citrate be neutralized by soda or potassa in place of ammonia, 
the sodio- citrate , or the potassio- citrate of iron is formed, which greatly 
resemble the ammonio-citrate. 

In ordinary cases of debility, requiring a chalybeate, especially where 
the stomach is irritable or where the alkaline carbonates are required to 
be combined, and in strumous affections of children, the ammonio-citrate 
is regarded as a valuable preparation. 

Its dose is from five to ten grains. 

A Citrate of Iron and Quinia, formed by the union of four parts 
of citrate of iron with one part of citrate of quinia, has, also, been in- 
troduced by M. Beral ; and is given in the form of pill, where a com- 
bination of these tonics is indicated. 

; 46. FERRI FILUM, IRON WIRE ; AND FERRI RAMEN'TA, IRON FILINGS. 

Iron wire and Iron filings are used in pharmaceutical preparations. 
Iron filings are also given internally ; in which case, they may act as 
mechanical tonics — like other insoluble substances ; and, like granular 
tin, may thus prove indirectly anthelmintic. Some change, however, 
takes place on iron filings in the stomach. They become oxidized by 
the decomposition of water, and hydrogen escapes, which gives rise to 
the unpleasant eructations experienced under their use. Like all the 
preparations of iron, too, they blacken the alvine discharges. When 
metallic iron is oxidized in the manner mentioned above, a portion of 
it is doubtless dissolved by the acids, which are almost always present 
in the stomach. 

Iron filings — as obtained from the shop of the blacksmith — are very 
impure ; but they are readily purified by placing a sieve over them, and 
applying a magnet, so that the filings may be drawn upwards through 
it. Their dose is from five to twenty grains, in molasses or honey ; but 
they are not often prescribed, as there are preparations of iron, which 
are far more effective. 

Iron wire is used in the preparation of Ferri Sulphas ; and iron fil- 
ings in that of Ferri Iodidum, and Liquor Ferri Iodidi of the Pharma- 
copoeia of the United States. 

Vol. II.— 5 



66 SPECIAL TONICS. 

An impalpable powder of iron has been strongly recommended in 
chlorosis and in different forms of anaemia. It is prepared by passing a 
stream of hydrogen over an oxide of iron in a gun-barrel exposed to a 
red heat. The hydrogen attracts the oxygen, and leaves the metallic 
iron in a state of extremely minute division. It is the Fer reduit par 
Phydroglne of the French pharmaciens. Owing to its great liability to 
oxidation, it should be kept in a well-stopped bottle. From ten to thirty 
grains may be given in the course of the day in honey or molasses. 

ZINCI SALESk— SALTS OF ZINC. 

The salts of zinc are not extensively employed as tonics. 

47. ZINCI OX'IDUM.— OXIDE OF ZINC. 

Oxide of zinc of most of the pharmacopoeias is prepared by decom- 
posing sulphate of zinc by means of carbonate of ammonia : the sul- 
phuric acid of the sulphate of zinc lays hold of the ammonia of the 
carbonate of ammonia, forming sulphate of ammonia, which remains 
dissolved in the distilled water employed ; whilst the carbonic acid 
unites with the oxide of zinc, and forms carbonate of zinc, which is 
insoluble, and precipitated. The carbonic acid is then driven off by ex- 
posing the carbonate to a strong heat. The Dublin College prepares 
the oxide by burning zinc in atmospheric air. It is "a white powder, 
which is insoluble in water, and devoid of taste and smell, and dissolves 
in dilute sulphuric and chlorohydric acids without effervescence ; whilst 
if carbonate of lead, or carbonate of lime, be present, effervescence 
ensues. Ferrocyanuret of potassium and sulpho-hydrate of ammonia 
throw down white precipitates. 

Oxide of zinc has been used as a tonic in various neuroses, — as 
epilepsy, chorea, neuralgia, gastrodynia, &c, but especially in the first 
of these diseases. It is now, however, not much employed, although 
well adapted for cases in which nitrate of silver, or some other of the 
mineral tonics has been prescribed ; and it is necessary to omit them for 
a time, and substitute another. The dose is from two to five grains two 
or three times a day, gradually increased. 

4S. ZINCI SULPHAS.— SULPHATE OF ZINC. 

Sulphate of zinc is, at times, used as a tonic in dyspepsia ; and is, 
occasionally, associated with antiperiodics — as cinchona or sulphate of 
quinia — in the treatment of intermittens. It is more frequently, how- 
ever, prescribed in the same neuroses as the oxide of zinc, over which 
it possesses no advantages. Its dose is from one to five grains, in the 
form of pill,— made with the extract of gentian, for example', as an 
excipient. 

49. ZINCI CHLO'HIDUM.— CHLORIDE OF ZINC. 

Chloride of Zinc or Butter of Zinc is readily formed by adding pure 



ZINCI ACETAS. 67 

oxide of zinc to any given quantity of pure muriatic or chlorohydric acid, 
applying a gentle heat until solution is effected, filtering the solution, 
and evaporating to dryness ; rubbing the resulting chloride to powder, 
and preserving it in a closely stopped bottle. In the Pharmacopoeia of 
the United States (1842), it is directed to be made by putting metallic 
zinc in sufficient muriatic acid to dissolve it ; then adding a small 
quantity of nitric acid, and evaporating to dryness ; dissolving the dry 
mass in water ; adding chalk to neutralize any acid ; filtering ; and 
again evaporating to dryness. 

Chloride of zinc is of a whitish colour, deliquescent, and wholly soluble 
in water, alcohol and ether. It is chiefly used as a caustic ; but has 
been sometimes given internally in the same affections as oxide of zinc. 
It may be prescribed in the dose of a grain, two or three times a day; 
or a solution in a spirit of ether may be made. (Zinci chlorid. gr. j ; 
Sp. JEther. sulphuric. f.Jij ; — Dose, five drops every four hours in sugared 
water, gradually increasing the dose to ten drops or more three or four 
times a day.) 

50. ZINCI CYANURE'TUM.— CYAN'URET OF ZINC; and 
51. ZINCI FERROCYANURE'TUM.— FERROCYAN'URET OF ZINC. 

Neither of these preparations is officinal in the Pharmacopoeias of 
Great Britain, or of this country. The former is made by the decom- 
position of sulphate of zinc by cyanuret of potassium, or cyanuret of 
lime; the latter by the mutual decomposition of boiling hot solutions of 
sulphate of zinc, and ferrocyanuret of potassium. 

They have both been used in the same class of cases as the other 
preparations of zinc. The dose of the cyanuret is from j\ to T2 tn of a 
grain several times a day, gradually increasing the dose to a quarter of 
a grain. Of the ferrocyanuret, the dose is from one to four grains. 

52. ZINCI ACE'TAS.— ACETATE OF ZINC 

Acetate of zinc is usually formed by the double decomposition of 
sulphate of zinc and acetate of lead ; — the sulphuric acid of the sulphate 
of zinc uniting with the lead of the acetate of lead, and forming an in- 
soluble compound ; whilst the acetic acid of the acetate unites with the 
oxide of zinc of the sulphate, and remains dissolved in the distilled 
water employed. The solution is then evaporated to crystallization. 
This was the process adopted in former editions of the Pharmacopoeia 
of the United States ; but in the last, acetate of lead is dissolved in 
water; and metallic zinc, granulated, is added to the solution, and 
shaken with it until the liquid yields no precipitate with iodide of 
potassium. The solution is then evaporated to crystallization. The 
crystals are white ; have a silky lustre, dissolve readily in water, and 
are slightly efflorescent. It is devoid of odour, and has a bitter metallic 
taste. 

It is but little prescribed internally, and possesses no advantages 



68 SPECIAL TONICS. 

over the other salts of zinc already described. It may be given in the 
same diseases, in the dose of one or two grains, gradually increasing 
the quantity. The excipient may be the extract of gentian. 

Valerianate of Zinc has been extolled by some of the Italian phy- 
sicians as a remedy in several nervous diseases. It is formed by adding 
protoxide of zinc to the vegetable acid to saturation, and then slowly 
evaporating the solution. A note on the mode of preparing the salt 
has been published in the American Journal of Pharmacy, by Mr. Wm. 
Procter, Jun., which may be consulted with advantage by the pharma- 
cien. It is given in the dose of one or two grains in the form of pill. 
It has been used with marked benefit in neuralgia ; and has been pre- 
scribed in other neuroses. 

53. ARGEN'TI NITRAS.— NITRATE OF SILVER. 

Nitrate of silver, — prepared for the purposes of pharmacy, by dis- 
solving silver in dilute nitric acid; heating the solution and gradually 
increasing the heat until the resulting salt is dried ; melting this in a 
crucible ; continuing the heat until ebullition ceases, and immediately 
pouring it into suitable moulds, — is at first white, but becomes dark on 
exposure to light. It is wholly soluble in distilled water ; and the solu- 
tion yields with chloride of sodium a white precipitate, which is wholly 
soluble in ammonia. 

It has been employed as a tonic in diseases of the nervous system; 
but chiefly in epilepsy and chorea; and the author is disposed to think, 
that he has seen more efficacy from it in the former disease than from 
any other agent. Of course, it can only be serviceable, where there is 
no serious disease of the nervous centres. There is, however, a striking 
objection to its use, in the fact, that, when long continued, it has pro- 
duced a slate colour of the whole cutaneous surface, which has con- 
tinued for the remainder of existence. In an instance which fell under 
Dr. Pereira's notice, the patient, a highly respectable gentleman residing 
in London, was obliged to give up business in consequence of the dis- 
coloration, for when he went into the street the boys gathered around 
him, crying out, " There goes the blue man !" In this instance no 
perceptible diminution of the colour had occurred for several years ; 
but in some cases it becomes less. In one case, the colour is said 
to have been diminished by washes of dilute nitric acid. The colora- 
tion is rare, for although the author has prescribed the salt largely, and 
for a long period, he has never witnessed a single case. When it does 
occur, it would appear to be owing to the nitrate of silver being con- 
verted into chloride by the chlorohydric acid of the stomach. The 
chloride passes into the blood in this state, and is deposited in the 
corpus papillare. If chloride of silver be moistened, and exposed to 
the air, it acquires the colour in question. 

In explanation of this colour produced in the skin by the nitrate, 
and supposed by some to depend on the decomposition of the tissue, 
Professor Krause has stated, that if thin cut layers of epidermis 



ABGENTI NITRAS^ 69 

soaked in a solution of nitrate of silver be exposed to the light, and 
then made transparent by acetic acid, their texture may be seen to be 
unaltered ; but there are very dark granules from K^th to 15 1 00 th of a 
line in diameter, on the outside of the larger cells, which are, no doubt, 
chloride of silver and reduced silver, and to these, not to a decomposed 
tissue, the change of colour is due. 

It has been affirmed, that a combination of nitrate of silver with iodine 
prevents the discoloration ; and a formula for the purpose has been pre- 
scribed by Dr. Patterson, of Scotland. (R. Argent, iodid., argent, 
nitrat. aa. gr. x. Rub into a subtile powder, and add glycyrrhiz. pulv. 
5ss ; sacchar. 3'i ; mucilag. acacix q. s. ut fiant pil. xl. Dose, — one, three 
times a day.) Experience is required to decide whether the iodine pos- 
sesses the property ascribed to it. As the nitrate may possibly induce 
the colour, it becomes the physician to state this to the patient, espe- 
cially if a female, in order that if she consent to take it, she may have 
no cause of complaint afterwards. There is little or no danger, how- 
ever, of its occurring under two months use of the article. 

In chorea, as well as in another neurosis — angina pectoris — this tonic 
has proved of service ; and it has succeeded in allaying morbid sensi- 
bility of the stomach, even when this has arisen from cancer. In such 
cases, it is of course only a palliative. The dose of the salt, as a tonic, 
is a quarter of a grain, three times a day, gradually increased to four or 
five grains. It may be made into a pill with extract of gentian or of 
dandelion. Crumb of bread has been objected to as an excipient on 
account of its containing chloride of sodium ; but this objection is only 
plausible, inasmuch as the salt must meet with chlorohydric acid in the 
stomach. 

The disagreeable taste of the nitrate prevents it from being given in 
solution. 



Mr. Lane is of opinion, that when the chloride is conveyed to the 
cutaneous surface, it is converted into an oxide by the action of light 
and its strong affinity for albumen ; and under the view, that the Oxide 
of Silver may serve the purposes of the nitrate he has prescribed it as 
a tonic in half grain doses, twice a day, especially in cardialgia, gastro- 
dynia and irritability of the stomach. It does not seem in any of the 
cases to have caused discoloration of the skin ; but sufficient trials have 
not been made to determine that it is less likely to induce it than the 
nitrate. 

Sir James Eyre has also highly extolled the oxide, in half grain doses, 
which, he says, uniformly succeeded in curing pyrosis. 

It has been recently affirmed by Dr. Branson, of Sheffield, that when 
nitrate of silver has been given for some time it produces a blue dis- 
coloration of the gums similar to that caused by lead. 

Chloride of Silver has the same tonic properties as the oxide and 
nitrate. Its dose is from one to three grains or more, two or three times 
a day. 



70 SPECIAL TONICS. 



54. BISMU'THI SUBNI'TRAS.— SUBNI'TRATE OF BISMUTH. 
i 

Subnitrate of Bismuth, White Bismuth, Nitrate of Bismuth, Trisni- 
trate of Bismuth, is prepared by dissolving bismuth in dilute nitric acid; 
and pouring the solution into distilled water. The powder that sub- 
sides is the subnitrate. In this process, a part of the nitric acid is 
decomposed, and furnishes oxygen to the bismuth; the oxide of bis- 
muth is then dissolved by the remainder of the nitric acid. On the 
addition of water to the solution of this nitrate, it is decomposed into 
subnitrate and supernitrate, — the former, being precipitated, and the 
latter remaining in solution. 

The subnitrate is a white powder, without taste or smell, and very 
slightly soluble in water. It is blackened by sulpho-hydric acid. 
Should it contain carbonate of lead or earthy carbonates, it will effer- 
vesce on the addition of nitric acid ; and if lead be present, sulphuric 
acid, added to the solution in nitric acid, will throw down a white pre- 
cipitate. 

Subnitrate of bismuth has been employed in various neuroses, — as 
epilepsy, nervous palpitation, and spasmodic diseases in general. It is 
most frequently administered, however, in neuropathic affections of the 
stomach, — as the various forms of cardialgia and gastrodynia, in which 
it is said to have been found efficacious by many ; but it has not 
answered any very satisfactory purpose in the author's practice. M. 
Royer has employed it with marked advantage in the diarrhoea of phthisis 
and typhus ; and it has been used in the latter disease in children. 

The dose is five grains gradually increased to a scruple or more, two 
or three times a day, in pill, or in honey or molasses. In large doses 
it is said to induce considerable gastric and encephalic disorder, like 
that which is caused by acro-narcotic poisons ; yet a recent writer — M. 
Monneret, of Paris, — affirms, that in much larger doses than are usu- 
ally given, it is of the greatest value in gastro-enteric affections, espe- 
cially such as are attended with fluxes. " He has never given less than 
from two to three drachms a day, nor more than twenty ; and has never 
observed the slightest inconvenience from these large doses ; and it is 
stated to be his custom to give it to the children in his hospital by 
spoonfuls or table-spoonfuls, without observing more exactitude, so in- 
nocuous is it." 

Dr. Pereira seldom commences it in less than a scruple dose, and 
has repeatedly given half a drachm without the least inconvenience. 
It is evidently, therefore, not as potent an article, in its action on the 
economy, as has been generally imagined. 

CUPRI SALES. SALTS OF COPPER. 

Three of the salts of copper are prescribed as tonics, and in analo- 
gous cases, — the acetate, the sulphate, and ammoniated copper. 



CUPRUM AMMONIATUM. 71 



65. CUPRI SUBACE'TAS— SUBACETATE OF COPPER. 

Subacetate of Copper, JErugo, Verdigris, is an impure subacetate, 
which is prepared on a large scale in the south of France, by allowing 
the refuse of grapes, in making wine, to ferment with sour wine, and 
then placing them between plates of copper. In the course of a fort- 
night, the plates become covered with subacetate of copper. In Great 
Britain it is made by interposing, between the plates of copper, cloths 
steeped in pyroligneous acid. The verdigris used in this country is 
imported from the south of France. 

The appearance of verdigris is well known. It is of a pale bluish 
green colour ; has a disagreeable acetous odour, and a coppery taste. It 
is insoluble in alcohol; and water resolves it into a soluble acetate, and 
an insoluble subacetate. 

In consequence of its powerful action in an overdose, subacetate of 
copper is rarely given as a tonic. It may, however, be prescribed in 
the same cases as the other salts of copper. Its dose, as a tonic, is from 
one-eighth to a quarter of a grain in pill. 

56. CUPRI SULPHAS —SULPHATE OF COPPER. 

Sulphate of copper has been given as a tonic in the same neuroses as 
the nitrate of silver, and especially in epilepsy and chorea, in which it 
would appear to have occasionally rendered essential service. It is not 
as often prescribed, however, as the next article. The dose, as a tonic, 
is a quarter of a grain three times a day, made into a pill with extract 
of gentian, or extract of dandelion ; and the quantity of the sulphate 
may be gradually increased to a grain and a half, or two grains, so as 
not to occasion vomiting. 

57. CUPRUM AMMONIA'TUM.— AMMONIATED COPPER. 

Ammoniated Copper, Ammonio- sulphate of Copper, Cup ro- sulphate 
of Ammonia, Ammoniuret of Copper, is made by rubbing together 
Sulphate of Copper and Carbonate of Ammonia, until effervescence 
ceases ; the ammoniated copper is then dried, and kept in a well stopped 
glass bottle, — as, when the salt is exposed to the air, ammonia is given 
off, and a green powder left, composed of sulphate of ammonia and 
carbonate of copper. When sulphate of copper and carbonate of am- 
monia are rubbed together, a reaction takes place between them ; they 
give out a part of their water of crystallization, so that the mass becomes 
moist ; and, at the same time, a part of the carbonic acid of the carbo- 
nate of ammonia is evolved, which causes effervescence. The precise 
theory of the process, and character of the product, are not, however, 
known ; and in the uncertainty the framers of the Pharmacopoeia of the 
United States have given the preparation the name at the head of this 
article. It is of a deep blue colour; with a strong odour of ammonia, 
and a styptic metallic taste. When exposed to the air, it loses ammonia, 



72 SPECIAL TONICS. 

and becomes of a green colour. It is soluble in water ; but if the so- 
lution be much diluted it is decomposed, and subsulphate of copper is 
thrown down. 

Ammoniated copper resembles in its remedial action the sulphate ; 
and has been given in the same cases, especially in epilepsy, and chorea. 
In the former disease, it has been highly extolled by many. When taken 
in too great quantity it produces the same effects as the other salts of 
copper. The dose is from a quarter to half a grain, two or three times 
a day, gradually increased to four or five grains and more. It is best 
given in the form of pill made with crumb of bread, or with the extract 
of gentian as an excipient. 

58. AC'IDUM SULPHU'RICUM.— SULPH'URIC ACID. 

Sulphuric acid is obtained by burning sulphur, united with nitrate of 
potassa, over water in an appropriate chamber. The sulphur, if burnt 
alone, would yield sulphurous acid ; the nitrate of potassa is added to 
furnish by its decomposition the oxygen necessary to form sulphuric acid. 
The precise steps in its preparation, and the theory of the process, be- 
long properly to chemistry. It is always prepared on the large scale by 
the manufacturing chemists ; and, therefore, is in the materia medica 
list of the Pharmacopoeia of the United States, which directs, that it 
should be of the specific gravity 1.845; be colourless; volatilizable 
by a strong heat ; and, when diluted with distilled water, be not 
coloured by sulphohydric acid. Should it be so, it contains sulphate 
of lead. 

Sulphuric acid, properly diluted, is used as a tonic in the same cases 
as nitric acid. It is often given alone, or associated with bitters, in 
convalescence from fever, as well as in the course of long protracted 
fevers. In cases in which there is a deficiency of acid in the stomach, 
as in what has been called neutral ox alkaline indigestion, it is very often 
serviceable, and has even been found of more advantage than the 
muriatic acid ; although the latter is one of the acids secreted by the 
stomach in health. It is also prescribed in the phosphatic diathesis, in 
which its tonic agency is, doubtless, of service. 

The acid, in its state of concentration, being so highly corrosive, a 
formula is contained in the pharmacopoeias for a diluted acid. 

AC'IDUM SULPHU'RICUM DILU'TUM, DILU'TED SULPH'URIC ACID. [Add. sul- 
phuric, f Jj ; Aq. destillat. fjxiij.) The specific gravity of this acid is 
1.09. It may be given in the dose of from ten to thirty drops, three 
times a day, in a wine-glassful of sweetened water. As the teeth are 
apt to be injured by the mineral acids, they may be sucked through a 
glass tube or quill. 

AC1DUM SULPHU'RICUM AROMAT'ICUM, AROMATIC SULPH'URIC ACID, Elixir 
of Vitriol. (Acid, sulphuric, f.^iiiss ; Zivgib. contus. 1] ; Cinnam. cont. 
3iss ; Alcohol. Oij.) The aromatics and the alcohol render the sulphu- 
ric acid more excitant, and greatly more agreeable. Accordingly it 



ACIDUM NITRICUM. 73 

is far more frequently prescribed as a tonic than the diluted sulphuric 
acid. 

Its dose is from ten to thirty drops, two or three times a day, in a 
glass of water. 

59. A"CIDUM NI'TRICUM.— NITRIC ACID. 

Nitric acid is obtained by the action of sulphuric acid on nitrate of 
potassa ; the sulphuric acid laying hold of the base of the nitrate, and 
the nitric acid being disengaged, and collected in an appropriate re- 
ceiver. It is an article, which is always prepared, in this country, by 
the manufacturing chemist ; and, therefore, in the Pharmacopoeia of 
the United States, is placed in the list of the materia medica, with the 
direction that it must be of the specific gravity 1.5; be colourless; 
entirely volatizable by heat; dissolve copper with the disengagement 
of red vapours — owing to the escape of binoxide of nitrogen; and, 
when diluted with distilled water, yield no precipitate with nitrate of 
silver, or chloride of barium ; — thus showing, that it contains neither 
chlorohydric nor sulphuric acid. 

When in its state of concentration, this acid is so corrosive as not to be 
very manageable ; a formula is, therefore, given in the pharmacopoeias 
for a diluted acid. It has been much used as a tonic, alone, or associated 
with bitter infusions, in adynamic fever; and in cases of phosphatic de- 
positions from the urine has been supposed to act beneficially through 
its tonic powers. Dr. Christison affirms, that the urine has never been 
rendered acid by it in his hands ; so that whatever good it accomplishes 
must, he thinks, be by some other means than by its rendering the 
morbid urine acid. He supposes, also, that the benefit ascribed to it 
in hepatitis may be through its tonic action. It is not much used. 

The dose of the strong acid is five to ten minims in a wine-glassful 
or more of water. 

AC'IDUM M'TRICCI DEUTUM, DILU'TED NITRIC ACID. {Add. nitric. f.§j ; 
Aq. destillat. f.^ix.) The dose of this is from forty minims to f.3iss in 
water. Its specific gravity is 1.08. 

In cases in which the British and American practitioners employ sul- 
phuric and nitric acids, the Germans prescribe phosphoric acid. 

II. Antiperiodic Tonics. 

Under this head are comprised tonic agents, which are chiefly em- 
ployed with the view of preventing those diseases, that are distinguished 
by marked periodicity. It has been before observed, that most of the 
tonics already considered have been occasionally employed as antipe- 
riodics in intermittent fever ; but, at the present day, they are rarely 
given as such ; whilst those, that have to be described under this 
head, are almost exclusively relied upon. Again, most of the antipe- 
riodic tonics may be employed in asthenic cases, in which tonics in 



74 



SPECIAL TONICS. 



general are indicated ; but in this relation they offer, perhaps, no pre- 
eminence. 



Fig. 139. 



60. CINCHONA.— PERUVIAN BARK. 

The terms Cinchona, Peruvian Bark, Bark, are employed pharma- 
cologically for the bark of different species of cinchona ; Sex. Syst. 
Pentandria Monogynia ; Nat. Ord. Rubiaeese, (Jussieu)— Cinchonacese, 

(Lindley,) obtained from the 
western coast of South Ame- 
rica. Of these, the Pharma- 
copoeia of the United States 
has admitted three varieties 
— I. Cinchona flav a, Yellow 
Bark, the variety known in 
commerce under the name 
Calisaya Bark ; 2. Cinchona 
pallida, Pale Bark ; the va- 
riety called in commerce 
Loxa Bark; and 3. Cincho- 
na rubra, Red Bark, the 
variety known in commerce 
under the latter name. Each 
of these requires a separate 
consideration ; but it maybe 
well to premise a few ob- 
servations, that are 
applicable to the 
whole. 
J. Although the bo- 
Aj| tanical history of so 
^ interesting a subject 
as that of the cincho- 
na barks has been 
attentively studied, 
it is by no means 
understood even at the present day: until, recently, indeed, the most 
erroneous views were entertained in regard to it, owing to the jealousy 
of the Spanish government, who appear to have thrown every obstacle 
in the way of the inquiring naturalist. Even now, in the London Phar- 
macopoeia, the three varieties, yellow, pale, and red bark, are referred re- 
spectively to Cinchona cordifolia, C. lancifolia, and C. oblongifolia ; 
yet it has been sufficiently shown, that we are still ignorant of the source 
of the two last varieties, and that the pale barks are derived from dif- 
ferent species. Twenty-six species of cinchona are now pointed out 
by botanists, of which twelve, at least, are thought to furnish a part of 
the barks that are used. (Lindley.) All the species are either tali 
shrubs, or large forest trees ; are commonly evergreen, and of great 
beauty, both in foliage and flower. They inhabit the Andes at various 
elevations from 11° N. L. to 20° S. L. The best bark is said to be 




Cinchona Condaminea. 
a. Calyx. 6. Ovary and style, c. Corolla, d. Capsule split into two 
cocci, e. Capsule divided, showing the two cells. /. Seeds in capsule 
g . Single seed. 



CINCHONA. 75 

obtained from the trees that grow on a dry rocky soil. The bark 
peelers or Cascarillos commence their operations in May, when the dry 
season sets in, and end in November. The quantity of bark exported 
is enormous, — to such an extent, indeed, that scarcity has been appre- 
hended, and under such a feeling, the government of Bolivia, in 1838, 
issued a proclamation forbidding the collection of bark in its territory 
for five years. 

Cinchona is shipped from various ports of the Pacific, — the most 
common being Arica, Valparaiso, Lima, Callao, and Payta. The 
quantity received into England in different years has varied greatly. 
In 1830, 556,290 lbs. were imported ; of which 56,879 lbs. were re- 
tained for home consumption. This appears to have been the largest 
quantity imported in any one year. In 1841, according to Dr. Pereira, 
81,736 lbs. paid duty. 

The arrangement of the cinchonas, adopted in the Pharmacopoeia of 
the United States, is according to the colour of the barks; for although 
— as has been correctly remarked — dependence cannot be placed upon 
this property alone, as barks of a similar colour have been found to 
possess very different virtues, and between the various colours con- 
sidered characteristic there is an insensible gradation of shade, still the 
most valuable barks may be arranged in three groups — the yellow, pale, 
and red, between which there is, in general, a well-marked distinction. 

I. Cinchona Flava, Yellow Bark. — Yellow Bark, it has been said, 
is generally known in commerce under the name Calisaya Bark. The 
London College refers it to Cinchona cordifolia, but the precise species 
that yields it is unascertained. It is produced most abundantly, if not 
exclusively, in the province of La Paz or its neighborhood in Bolivia, 
whence it is conveyed to the Pacific and shipped at Arica. Two va- 
rieties are met with in commerce, the quilled and the flat ; the former 
is in pieces, generally from nine to fifteen inches long, from one to two 
inches in diameter, and from an eighth to a third of an inch in thick- 
ness. Some quills are considerably smaller ; but such fine quills are 
not seen in it as form a considerable proportion of the pale barks. The 
external surface of the quills is marked by longitudinal wrinkles and 
furrows ; and by transverse cracks, which cause the external surface of 
the bark to be very rough. The colour of the epidermis is of a more 
or less light gray. This epidermis yields a dark red powder ; is taste- 
less, and possesses none of the virtues of the bark. The outer surface 
of the bark, where the epidermis is wanting, is of a brown colour. 

The flat calisaya or flat yellow bark possesses the characters of the 
quilled variety, except that the pieces which are stripped of their epi- 
dermis have externally the cinnamon-brown colour of their inner sur- 
face, and are free from cracks and wrinkles. They are in pieces either 
quite flat or but slightly curved. When the epidermis exists, the bark 
presents the same external appearance as the quilled variety. The inner 
surface of both varieties is smooth, and of a cinnamon colour. In 
commerce, the flat variety is divided into the coated and the uncoated. 

Yellow bark resembles in taste and smell the pale variety ; but it is 
stronger. It yields more sulphate of quinia than any other kind of cin- 



76 SPECIAL TONICS. 

chona bark, and hence is more largely consumed than any other. In 
the year 1827, M. Pelletier used 2000 quintals, equal to 200,000 lbs., 
in the manufacture of 90,000 French ounces of sulphate of quinia, 
about three drachms of the sulphate to one pound of bark. Chemical 
analysis would seem to have shown that the flat variety of yellow bark 
is to be preferred ; and it is stated that one French pound of uncoated 
yellow bark yields from 30 to 50 grains more of the sulphate than the 
coated variety. 

II. Cinchona Pallida, Pale Bark. — The finest specimen of this is 
Crown or Loxa Bark, Crown Bark of Loxa, of commerce, which is 
referred by the London College to Cinchona lancifolia. It is Cin- 
chona coronce of the Edinburgh Pharmacopoeia ; is the bark of Cinchona 
condaminea, and is collected in the provinces about Loxa. Under the 
name Loxa Bark, however, in the United States, are included all the 
pale barks. (Wood and Bache.) As met with in the shops, pale bark 
is in quills, which are in length from six to fifteen inches, single or 
double, straight or nearly so, and varying in diameter from the size of a 
crowquill to that of the thumb, or somewhat larger, — and in thickness 
from one-third of a line to two lines. The epidermis is always on ; so 
that in the case of the pale bark, there are no two varieties, — the coated 
and the uncoated, — as in the case of the yellow bark. The epidermis 
has numerous transverse cracks. In the fine quills, these are hardly 
visible ; but longitudinal furrows are observable as well as in the larger 
quills. The external surface of the epidermis is of a grayish colour; 
owing chiefly to the lichens that cover it, and sometimes inclining to 
liver-brown. Gray, or grayish-brown is the predominant tint. The 
inner surface, and the powder, are-of a deep cinnamon brown colour; 
— the former, in the finer kinds, is smooth ; m the coarser, rough occa- 
sionally. It has a bitter, aromatic and astringent taste, and a smell 
somewhat resembling that of tan. The finest quills are most prized ; 
but those of the middle size are considered by Dr. Christison to be 
really the best. 

The pale barks differ from the yellow in containing cinchonia in the 
place of quinia. In this country they are much less used than they 
were formerly, the red bark being preferred by many physicians, whilst 
the yellow, as already shown, is employed for the formation of the sul- 
phate of quinia. 

III. Cincho'na Rubra. Red Bark. — The botanical origin of this 
variety of cinchona is unknown. The London and Dublin Colleges 
refer it to Cinchona oblongifolia ; but the Edinburgh considers it to be 
the bark of an unascertained species. Like yellow bark, it is imported 
in quills, and in flat pieces, — the latter being the more common of the 
two, and occasionally, very large, as if taken from the trunk of a tree, 
from two inches to two feet in length, and one to five inches in breadth, 
and from one quarter to three quarters of an inch in thickness. It is 
generally coated, or covered with epidermis, which is rough, wrinkled 
longitudinally, furrowed, and often warty. The colour is reddish 
brown, with a grayish hue in the hollows, owing to adhering lichens. 



x 



CINCHONA. 



77 



The inner surface is of a deep cinnamon brown, inclining to reddish 
brown ; and the colour of the powder is so much redder than that of 
the preceding varieties as to render the epithet red bark appropriate. 
The taste is bitter, somewhat aromatic, and astringent. 

The quilled variety is a species of about the same size as quilled yel- 
low bark. These are of a paler reddish brown externally than the flat 
pieces, and internally of a clearer cinnamon brown colour, approaching 
that of yellow bark. On the epidermis are frequent patches of pale 
gray efflorescence from lichens. The colour of red bark in general is 
faint reddish brown, and the odour is feebly tan-like. It is distin- 
guished from the varieties already considered by containing both quinia 
and cinchonia in considerable quantities. This fact ought to cause it to 
be more largely used ; yet in Europe it is so little employed that it re- 
ceives scarcely any attention. (Pereira.) 

Fig. 140. 




Cinchona Micrantha, 



Such are the varieties of cinchona that are officinal in the Pharmaco- 
poeia of the United States. There are many other varieties, however, 
which are genuine cinchona barks ; and yet have not been considered 
worthy of an officinal position. The Edinburgh Pharmacopoeia admits, 



78 SPECIAL TONICS. 

indeed, Cinchona cinerea, Gray Bark, Silver Bark, or Huanuco Bark, 
which is obtained around Huanuco, in Peru, and belongs to the class of 
pale barks. Amongst the genuine, but inferior barks, are the Cartha- 
gena Barks, which are brought from the northern Atlantic ports of 
South America : the characters of these, and, indeed, of all the cin- 
chonas, have been well and fully described by Dr. Pereira. 

It was to be expected, that so valuable a bark as genuine cin- 
chona should be subject to adulteration. The most important spurious 
barks are the Piton or St. Lucie Bark, from Exostemma Jloribundum 
of the West Indies ; the Caribbean Bark from Exostemma Caribceum, 
likewise of the West Indies ; and the Pitaya Bark, also supposed to be 
the bark of an exostema. They contain neither quinia nor cinchonia. 
The most common sophistication is in the case of the powder, which 
may be adulterated with spurious barks or inert matter, and require a 
very experienced individual to detect the fraud. 

The different barks have been classed by Mr. Lindley after their phy- 
sical characters. 



a. Pale Barks. 

Crown or Loxa • • . Cinchona condaminea. 
Gray, or Silver, or Huanuco, . C. micrantha. 
Ash, or Jaen, .... Unknown. 
White Loxa, .... Unknown. 

b. Yellow Barks. 

Yellow,. .... C. lanceolata; also C. hirsuta, and C. nitida. 
Calisaya, . . . . C. lanceolata. 
Carthagena, . . . . C. cordifolia. 
Cusco, Unknown. 

c. Red Barks. 

Red bark of Lima, . . . Unknown. 
Cinchona nova, . . . C. magnifolia. 

d. Brown Barks. 

Huamalies, . . . • C. purpurea. 

The barks falsely called Cinchonas, which do not yield the cinchona 
alkaloids, are, according to Drs. Pereira and Royle, 

St. Lucie bark, . . . Exostemma floribundum. 

Jamaica bark, . . . Caribaeum. 

False Peruvian bark, . . Peruvianum. 

Brazilian bark (Quina de Pianky), Souzanum. 

Pitago bark, .... Malinea (?) racemosa, &c. 

The chemical investigations in regard to Cinchona are extremely in- 
teresting ; and the results have furnished most valuable aids to thera- 
peutics. It is only, however, within a little more than a quarter of a 
century, that our knowledge of them has been rendered precise ; and 
chiefly through the labours of two skilful French analytical chemists, 
MM. Pelletier and Caventou. The following, according to Dr. Pe- 
reira, may be regarded as the constituents of the three varieties of 
genuine barks — pale, yellow and red. 







CINCHONA. 
















Pale. 


Yellow. 


Red. 


1. 

2. 


Kinate of cinchonia, 


. 


-f- 
•f- 


+ 
■+ 


+ 

4 




... 


3. 


Soluble red colouring matter, {tannin,') 


+ 


+ 


+ 


4. 


Insoluble do. 


(red cinchonic,') 


+ 


-f- 


+ 


5. 


Yellow colouring matter, 


. 


+- 






•+ 


6. 


Green fatty matter, 


. . 


+ 






+ 


7. 


Kinate of lime, 


... 


-h 






+ 


8. 


Starch, 


. . • 


-h 






-f 


9. 


Gum, 


. . . 


-f- 








10. 


Lignin, 


. 


-r- 


+ 


+ 



79 



Cinchonia and quinia, the alkalies on which the chief medical vir- 
tues of cinchonia are dependent, exist in the bark in combination with 
kinic acid. The quantity yielded by the different varieties varies, and 
it would appear, that the same variety may yield different quantities, 
which may account for the discrepancy in the results obtained by dif- 
ferent chemists. Thus, Dr. Christison states that an English manu- 
facturer informed him, that 100 pounds avoirdupois of good yellow bark 
afforded him sometimes 50, sometimes only 25 ounces of sulphate of 
quinia — that is from 31.25 to 15.6 parts in 1000 ; or from 23.4 to 11.7 
of quinia. 

Besides cinchonia and quinia, another alkali has been discovered in 
Arica or Cusco cinchona, to which the name Aricina has been given. 
It is not, however, of any therapeutical interest. Other alkaloids are, 
likewise, said to have been found ; but their existence is not considered 
to be established. The tannic acid which gives the astringency to 
bark, and which is obtained in greatest quantity in the red variety, is 
doubtless also concerned in its therapeutical action. Cinchonia and 
quinia, the latter of which is an officinal preparation, will receive a 
distinct consideration hereafter. 

The active ingredients of cinchona are imparted to water, alcohol 
and dilute acids ; and, accordingly, these menstrua are employed in the 
formation of different officinal preparations. Cold water makes an ex- 
cellent infusion, but does not extract the virtues, unless by the operation 
of displacement, as well as hot ; but the qualities of the different offici- 
nal preparations will require a separate mention. 

As an evidence of the value of the discovery of quinia, it may be 
stated, on the authority of a respectable druggist of this city, (Philadel- 
phia,) that although the best cinchona bark could not be purchased, at 
the time, for less than a dollar and thirty-seven and a half cents per 
pound, and in powder for less than one dollar and fifty cents ; cinchona 
powder — so called — could be obtained for ten cents a pound. This 
consisted of an admixture of false and other barks with cinchona or true 
barks; and generally, perhaps, not a particle of the latter could be de- 
tected in it. Yet the appearance of the true and the spurious powder 
was so nearly alike, that no difference could be observed even by an 
experienced eye. From July 1848, to April 1849, inclusive, Dr. Bai- 
ley, inspector of drugs at the port of New York, rejected 34,000 lbs. 
of spurious and worthless cinchona barks, which contained none, 
or but a trace, of the alkaloids of the true barks ; and he affirms, that 



80 SPECIAL TONICS. 

the cost of these barks, delivered in that market, was at the time about 
six cents a pound, whilst the genuine cost eighty cents ! 

Cinchona has been long celebrated as a tonic and antiperiodic ; 
and its efficacy in arresting the paroxysms of intermittents has acquired 
it the name of a febrifuge. It is not such in reality ; for it seems to 
exert no influence over the excited organic actions as they exhibit them- 
selves in ordinary fever. Its great power is in the period of apyrexia ; 
in which it seems to act upon the nervous system in the same way 
as other agencies that affect the nerves in a revellent manner ; and thus 
— as elsewhere remarked of antiperiodic tonics in general — breaks in 
upon the chain of associated actions, that constitute the disease. But 
it is not only in intermittent fever that it operates in this beneficial 
manner. In other diseases, not characterized by any excited condition 
of the organic actions, it equally destroys the morbid catenation ; and 
therefore the epithet antiperiodic is more appropriate to it ih^n febrifuge. 

Cinchona is an admirable tonic as w T ell as antiperiodic; and, as such, 
is largely employed. Most, however, of its medical virtues are com- 
prised in the salts of its alkaloids — especially the sulphate of quinia, 
which has, therefore, almost supplanted it. Still, as stated in the gene- 
ral consideration of tonics, there are cases in which sulphate of quinia 
fails as an antiperiodic ; and in which powdered cinchona succeeds ; 
partly, perhaps, on account of its containing, along with the alkaloid, an 
astringent principle ; and partly owing to the lignin or woody matter ; 
all of which combined may impress the nerves of the stomach more 
powerfully than sulphate of quinia alone. As a tonic, it may be pre- 
scribed in the same cases as tonics in general ; and the same observa- 
tions as were applied to them, in regard to the best forms for 
administration, are equally applicable to it. Of these, the cold infusion 
is to be decidedly preferred. Like tonics in general, apprehension need 
not be entertained, in doubtful cases, that cinchona may act injuriously 
as an excitant ; for when it has been administered in the hot stage of 
intermittents, it has not appeared to add to the excitement. 

Before its administration in intermittent fever, it is generally customary 
to prescribe an emetic of tartrate of antimony and potassa, or of ipeca- 
cuanha, or of both combined, and to follow this up by a brisk cathartic ; 
but in very malignant intermittents, time may scarcely be afforded for 
the latter. As a general rule, this course appears advisable ; the cin- 
chona usually making a more powerful impression, after the alimentary 
canal has been cleared of its contents, When it excites nausea, or runs 
off by the bowels, the addition of an excitant — as of five grains of 
ginger powder, or of Pulvis aromaticus, or a few drops of laudanum, 
may act as a corrigent. In cases in which it cannot be retained by the 
stomach, it has been administered in enemata, and in children especially 
has proved effectual ; three times the quantity that would be given by 
the mouth being thrown into the rectum. It was formerly, also, the 
practice to apply it to the surface of the body in the form of cataplasms, 
pediluvia, bark jackets, &c, but these are never directed at the present 
day by the physician. 
" In a simple case of intermittent, cinchona is generally sufficient to 



CINCHONA. 81 

prevent the paroxysm. Should the disease, however, be complicated 
with plethora, hyperemia of any organ, or gastric or intestinal derange- 
ment, it becomes necessary to remove these complications, before the 
remedy can exert its full powers. 

Intermittent and remittent fevers are not the only diseases in which, 
as before remarked, cinchona acts beneficially as an anti-periodic. In 
all affections that observe anything like a distinct periodical character, 
and recur at regular intervals, it often exhibits its powers most signally ; 
whilst in those that are very irregular, and where of course it is difficult 
to anticipate the precise period of attack, little or no reliance can be 
placed upon it. 

The dose of powdered cinchona,— which is the most effectual form, 
when it is desirable to make a decided impression, — is one drachm, re- 
peated more or less frequently. If half a drachm be given every hour, 
for eight hours before the anticipated paroxysm, a sufficient quantity may 
be taken to have a decided antiperiodic effect upon an ordinary ague ; 
and should {his not prevent the paroxysm, its repetition in the subse- 
quent interval may wholly arrest the disease. In the generality of cases, 
indeed, the author has succeeded in preventing the paroxysm by half 
a drachm given an hour and a half; and repeated an hour, and half 
an hour before its expected recurrence. 

In asthenia, either of the stomach or of the system generally, the 
watery or alcoholic preparations of cinchona are preferable, but if it be 
desired to exhibit the cinchona in powder, in these cases, the dose may 
be from ten to thirty grains. 

The taste of cinchona, when mixed with milk, is, according to Dr. 
A. T. Thomson, completely covered, provided the mixture be taken 
directly ; but if not taken immediately, the medicine soon communi- 
cates its taste to the milk. 

INFU'SUM CINCHO'M, INFUSION OF PERU'VIAN BARK. {Cinchon. cont. §j ; 
Jlquce bullient. Oj.) This may be prepared by maceration; or an infu- 
sion with cold water may be made by displacement or by maceration. 

Infusion of cinchona contains only a part of the virtues of the drug, 

a large portion of the kinates of the active principles remaining in the 
mass left on the strainer. It is the form generally used when the re- 
medy is given as a tonic. As an antiperiodic, it is not sufficiently 
potent. The dose is f.^iss to f.^ij three or four times a day. 

INFU'SUM CINCH0M COMPOSITUM, COMPOUND INFUSION OF PERU'VIAN BARK. 
( Cinchon. pulv. gj ; Add. sulphuric, aromat. f.Jj ; Aquse Oj.) The 
addition of sulphuric acid decomposes the kinates of the alkaloids, and 
probably secures the separation of the greater portion of active matter. 
Its dose is the same as the last. 

DECOC'TUM CINCHOM, DECOCTION OF PERU'VIAN BARK. {Cinchon. cont. 
3j ; Jlquce Oj.) It cinchona be boiled for a great length of time, the 
alkaloids form compounds with other constituents, which are sparingly 
soluble in hot water, and less so in cold ; so that as the decoction 
cools, they are deposited. This would be prevented by the addition of 

Voi,. II. — 6 



32 SPECIAL TONICS. 

aromatic sulphuric acid, as in the last preparation. The decoction 
contains much more of the active matter of the cinchona than the 
simple infusion ; still, it is rarely used as an antiperiodic. The dose is 
f.gss to f.Jiij. 

TINCTU'RA CINCHOM, TINCTURE OF PERUVIAN BARK. {Cinchon. pulv. 3vj ; 
Alcohol dilut. Oij ; prepared either by maceration or displacement.) 
Tincture of cinchona is rarely given alone, on account of the quantity 
of alcohol that is combined with an ordinary dose. It may however be 
prescribed in the dose of from f.£j to f.|ss in cases of atonic dyspepsia; 
and where the ordinary bitter tinctures are considered to be indicated. 
Usually, it is added to tonic infusions or decoctions,— as to Infusum 
cinchona, or Decodum cinchojiae ; in the proportion of from f-3j or f.^ij 
to f.5iss of either of these preparations. 

TINCTU'RA CINCHON! COMPOSTTA, COMPOUND TINCTURE OF PERUVIAN BARK. 

(Cinchon. pulv. 5ij ; Aurant. corticis contus. ^iss ; Serpentarise contus. 
3iij; Croci incis., Santal. rasur. aa 3j ; Alcohol, dilut. f.^xx ; made either 
by maceration or displacement.) This preparation is commonly sold as 
Huxham's Tincture of Bark. The addition of orange-peel as an exci- 
tant, and of Virginia snakeroot as an aromatic bitter tonic, renders this 
preparation more agreeable and excitant than the simple tincture. It 
may be given in the same cases. The dose is f-3j to f.§ss. 

EXTRAC'TUM CINCHOM, EXTRACT OF PERUVIAN BARK. This extract, in the 
Pharmacopoeia of the United States, is made by exhausting cinchona by 
means of alcohol, by the process of displacement, distilling off the alco- 
hol ; afterwards treating it with water ; mixing the infusions, and eva- 
porating to form an extract. The extract contains most of the principles 
of cinchona ; but it is rarely used. The dose is from gr. x to gr. xxx 
or more. 

QUl'NIA. — QUININE'. 

Quinia, Quina or Quinine — as already remarked — is one of the alka- 
loids to which cinchona owes its antiperiodic properties. The mode 
in which it is obtained will be apparent from considering the process for 
procuring the sulphate — the only officinal preparation in the Pharmaco- 
poeias of Great Britain and the United States. It is generally in the 
form of powder ; has a very bitter taste, and is very sparingly solu- 
ble in cold water. It possesses the same virtues as the sulphate ; and 
is, indeed, preferred by some as an antiperiodic. It may be given in 
the form of pill, in the same dose as the sulphate, or in alcoholic solu- 
tion. 

SULPHATE OF QUl'NIA, Disulphate of Quinia, Subsulphate of Quinia, 
Sulphate of Quinine, is prepared from yellow bark by the following pro- 
cess. The bark is boiled in water and muriatic acid, by which the 
kinate of quinia is decomposed, and muriate of quinia is formed ; the 
boiling is repeated on the residuum ; the decoctions are mixed ; and, 
whilst hot, lime is added, which unites with the muriatic acid, forming 
muriate of lime or chloride of calcium : this remains in solution, the 



QUINIA. 83 

quinia being precipitated. The precipitate is well washed with distilled 
water, pressed, dried and digested in alcohol, in fresh and fresh por- 
tions, until the spirit is no longer rendered bitter. The liquors are then 
mixed, and an alcoholic solution of quinia obtained. The alcohol is 
now distilled off". Upon the brown viscid mass remaining, distilled 
water is poured ; and the mixture being heated to the boiling point, as 
much sulphuric acid is added as is necessary to dissolve the nnpure 
alkali. In this way, a sulphate of quinia is formed. Animal charcoal 
is now added to the hot fluid to deprive the salt of any colouring mat- 
ter ; and after filtering the liquor whilst hot, it is set aside to crystallize. 
The salt may be rendered still more pure, hy dissolving the crystals, 
thus formed, in boiling water slightly acidulated with sulphuric acid ; 
adding a little animal charcoal ; filtering, and setting aside to crystal- 
lize. From the mother waters, an additional quantity of sulphate of 
quinia may be obtained by precipitating the quinia by solution of ammo- 
nia ; and treating it with water, sulphuric acid, and animal charcoal. 

The above is the rationale of the process, recommended in the last 
edition of the Pharmacopoeia of the United States. 

Sulphate of quinia is in white, filiform, silky crystals, of a snow- 
white colour, without smell, and of a very bitter taste. It is soluble in 
740 parts of cold, and in 30 of boiling water. It dissolves very readily 
in alcohol ; and in water acidulated with sulphuric acid, but is insolu- 
ble in sulphuric ether. It gives a blue tinge to water. 

The quantity of sulphate of quinia prepared is very great. In the 
year 1826, in two laboratories of Paris, it amounted to 59,000 ounces. 
In this country, it was formerly imported altogether from France ; but 
the author is informed, that from 40,000 to 50,000 ounces were made 
in Philadelphia in the year 1845. It is an expensive article ; and is, 
therefore, liable to adulteration. The chief articles, employed for this 
purpose, are sulphate of lime, sulphate of baryta, mannite, and starch; 
by digesting, however, the sulphate in alcohol, the salt is dissolved, 
whilst the sulphate of lime, the sulphate of baryta, starch and mannite, 
are left. 

Sulphate of quinia possesses almost all the medical virtues of cin- 
chona. It is an excellent tonic, and is the very best of the antiperi- 
odics. Hence, at the present day, no single article is so much employed 
in the various diseases that are characterized by periodicity. 

In impressible individuals, and in others, when given in very large 
doses, it disorders the gastro-enteric functions ; and induces phe- 
nomena resembling those caused by narcotic agents, — as restlessness, 
vertigo, confusion, depravation of vision, tinnitus aurium, and transient 
deafness. In certain cases, ptyalism would seem to have been induced; 
the saliva being inodorous, and the teeth firm. When calomel has 
been given along with it, it has been conceived, that ptyalism has en- 
sued sooner than it might otherwise have done. Like narcotics, too, 
it is decidedly sedative in large doses. 

It has now taken the place of cinchona in all periodical diseases. In 
intermittents, it is largely employed. In remittents of the pernicious 
class, it is often necessary to administer it when the subsidence of 



84 SPECIAL TONICS. 

symptoms is far from complete. It is one of the best remedies, too, in 
the engorgements of the spleen and the dropsical effusions, that are the 
consequences of intermittents ; but in such cases, it must be given in 
very large doses. It is said likewise, to have been found advantageous, in 
such doses, in the yellow fever of the southern parts of this Union ; and 
a recent writer— Dr. T. D. Mitchell— lays down the untenable posi- 
tion, that all fevers " possess one common property, which, confessedly 
under the control of the sulphate of quinia in the case of common ague 
and fever, is not less so in typhoid, typhus, congestive, yellow, and, it 
may be, all the fevers named in the books ;" and he assumes the posi- 
tion, "plainly and boldly," that "there is but one feature or element in 
either of the fevers named that is essential to its pathology, and that 
feature or property or element bows before the potent sway of the sul- 
phate of quinia, and for this reason only we cure the patient!" 

It is scarcely necessary to say that quinia and its preparations are not 
universally applicable. In remittents and intermittents, that are accom- 
panied by hyperemia of internal organs, such hyperemia must be re- 
moved before quinia or its salts can exert their efficacy ; and there is 
truth in the remark of Professor Dickson— that " they deceive themselves 
who regard quinia as a universal and infallible febrifuge, even in mala- 
rious fevers." 

Besides its antiperiodic virtues, it possesses— as already remarked— 
those of a tonic. There are many, however, who esteem cinchona to 
be preferable, as a tonic, to quinia ; and who administer the latter to pre- 
vent the paroxysms of an intermittent ; but prescribe the former, when 
they are desirous of strengthening the system and preventing a relapse. 

As an antiperiodic, it may be given in the quantity of from four to 
ten grains in the twenty-four hours. The author is in the habit, in 
cases of regular intermittents, of prescribing five grains, dissolved in 
water, about an hour before the expected paroxysm, and repeating it in 
the course of half or three quarters of an hour; and, should there be 
evidences of the return of the paroxysm notwithstanding, he prescribes 
fifty drops of laudanum. Under the joint action of the tonic and the 
narcotic, the paroxysm will generally be prevented, or be so far broken 
as to yield to a repetition of the treatment before the next expected 
paroxysm. It has, however, been given in much larger quantity than 
this, sometimes to the extent of thirty grains or more every hour, until 
upwards of ninety grains and more have been taken ; but it is question- 
able whether such large doses can be necessary. In the cases of yellow 
fever, before referred to, from a scruple to a drachm was given for a 
dose with signal success. 

Like cinchona, sulphate of quinia has been given largely in acute 
rheumatism — a disease, which is peculiar, — and, in the author's opi- 
nion, largely neuropathic. Some years ago, M. Briquet announced, 
that he had cured acute articular rheumatism, accompanied with violent 
pain, swelling, redness, fever, &c, in two or three days, w 7 ith sulphate 
of quinia, in doses of about a drachm and a half daily. Such doses, 
however, cannot always be given with impunity ; and whilst they were 
in vogue in Paris, they proved fatal — it is affirmed — in several cases. 
The author has often prescribed it in doses of from 20 to 30 grains in 



QUINI^ SULPHAS. 



85 



the 24 hours with decided advantage. Its febrifuge virtues are marked ; 
and instead of its acting as an excitant, the effects are those of seda- 
tion. This has been signally shown by some recent experiments of M. 
Brecquet, of Paris. In doses of fifteen grains and upwards, the pulse 
was reduced from eight to forty beats in the minute. 

It has been given to a great amount in this country. A medical 
friend of Dr. Dickson assured him, that in Alabama he had administered 
"thirty grains of a solution of sulphate of quinia every hour for seven- 
teen successive hours," and he states farther that he heard authentically 
of a western physician, " who emptied into the stomach of a patient 
labouring under bilious remittent an ounce bottle in one night." 
Dr. B. Rush Mitchell, in a case of congestive fever, gave thirty grains 
every half hour until two hundred and forty grains were taken in about 
four hours; and the patient recovered. Twelve grains are considered 
to be equivalent to about an ounce of good bark. 

Solution is a more disagreeable form of administration than pill ; but 
as it is important that the new nervous impression should be as forcible 
and extensive as possible, it must obviously be advantageous, that the 
gustatory nerves should be impressed as well as those of the stomach. 
The recent experiments of M. Brecquet satisfied him, that the solution 
is more active by one-half. The taste, left by it, is soon annihilated by 
chewing a piece of apple. 

Like cinchona, it may be administered per anum i and it has the ad- 
vantage, which cinchona has not, of being capable of employment 
endermically, when the condition of the stomach forbids its use by the 
mouth. Three times the ordinary dose may be added to a common I 
enema ; and when it is to be exhibited endermically, from four to eight ' 
grains may be sprinkled on the surface denuded by a blister. As much 
as two drachms has been applied in this manner. An ointment, com- 
posed of 3j of sulphate of quinia , and Jij of lard, has been rubbed into 
the axilla, with success, in cases of ague in children ; and it has been 
affirmed by M. Ducros, that doses of about three quarters of a grain, 
dissolved in ether and rubbed on the lining membrane of the mouth, 
cause a stronger and more rapid action than half a drachm given by the 
stomach. y» 

PILULE imiM SULPHA'TIS, PILLS OF SULPHATE OF QUINIA. (Quinia 

sulph. ^j ; Acacia pulv. ^ij ; Syrup, q. s. to make 480 pills.) Each 
pill contains a grain of sulphate of quinia. 

Besides the sulphate, other salts of quinia have been prescribed. 
Ac"etate of Qui'nia acts like the sulphate, but deserves no preference ; 
and the same may be said of Citrate of Qui'nia, Mu'riate of Qui'nia, 
and Nitrate of Qui'nia. Ferrocy'anate of Qui'nia is considered by 
some to possess antiperiodic properties, superior even to those of the 
sulphate, yet it'is but little used ; and Tannates of Qui'nia and Cin- 
cho'nia have been regarded as the most active of the combinations of 
the alkaloids. None of these are used on this side of the Atlantic. 
For a farther description of them, — as well as of an impure sulphate of 
quinia, called in a former edition of the Pharmacopoeia of the United 



86 SPECIAL TONICS. 

States, Quinije Sulphas Impurus, formed by evaporating the liquor 
poured off the crystals of sulphate of quinia to the consistence of a 
pilular mass, and which has been known, for years, in Philadelphia, 
under the name of Extract of Quinine — the reader is referred to another 
work, (New Remedies, 5th edit. p. 549, Philad. 1846). 

Cincho'nia, and Sulphate of Cincho'nia, are obtained from pale 
bark, by a process similar to that by which quinia and sulphate of qui- 
nia are obtained from yellow bark. It would appear that sulphate of 
cinchonia is equally effective as an ordinary and antiperiodic tonic with 
sulphate of quinia, — a fact which, as Dr. Pereira observes, acquires 
some importance from the apprehended failure of yellow bark, in which 
quinia abounds. 

Valerianate of Quinia has been lately introduced by M. Devay 
as superior to sulphate of quinia. The following is his mode of pre- 
paring it. To a concentrated alcoholic solution of quinia, valerianic 
acid in slight excess is added : the solution is diluted with twice its 
volume of distilled water ; and the whole is well stirred, and then 
placed in a sand-bath, the heat of which does not exceed 145° Fah. 
When the alcohol is evaporated, valerianate of quinia presents itself in 
beautiful crystals, which increase from day to day. 

As the salt is readily decomposable, M. Devay gives it in the most 
simple form, generally in a solution of gum arabic. The dose is from 
lj to 6 grains during the apyrexia. 

I'odidesof Qui'nia and Cincho'nia, described under Eutrophics, may 
be useful additions to the Materia Medica, — formed as they are by the 
combination of a valuable eutrophic and a tonic ; but their medicinal 
properties have not yet been fully tested. 

61. AC'IDUM ARSENIO'SUM.— ARSE'NIOUS ACID. 

Arsenious Acid, White Arsenic, White Oxide of Arsenic, occurs in 
nature, either tolerably pure, or combined with other metals or metallic 
oxides. White arsenic of the shops is understood, however, to be 
obtained from the refuse found in the flues of furnaces where other 
metallic ores undergo the process of roasting; and more especially 
from the refuse of the roasting of the arseniuret of cobalt. The impure 
material from the flues is subjected to a second sublimation; which 
renders it sufficiently pure for medicinal purposes. It is prepared in 
Silesia, Bohemia, Saxony and Cornwall ; and the precise processes 
adopted in each of these places are described at some length by Dr. 
Pereira. From Penryn, in the last place, not less than 600 or 800 tons 
are shipped annually. That which is used in this country comes chiefly 
from Hamburg and Bremen. (Wood & Bache.) 

Recently sublimed arsenious acid is in masses, which are convex on 
one side, and concave on the other; taking the shape of the vessel used 
in the sublimation. The cakes are transparent, and of a vitreous 
appearance ; but they soon become opaque and white externally, the 



ACIDUM ARSENIOSUM. 87 

opacity gradually extending from the circumference to the centre. It 
is entirely volatilized by heat ; emits an alliaceous odour when thrown 
on ignited charcoal, and is completely dissolved by boiling water. It 
has little or no taste, and is devoid of smell; but if left for some time 
in contact with the lining membrane of the mouth or nostrils, it causes 
considerable irritation. Boiling water dissolves about one-ninth of its 
weight, and on cooling to 60° retains l-35th. Temperate water takes 
up scarcely l-400th of its weight. (Christison.) The presence of or- 
ganic matters very much impairs the solvent powers of water in regard 
to it, which accounts for arsenious acid not having been found in the 
liquid contents of the stomachs of those who have been poisoned by it. 
(Pereira.) The adulterations of arsenic are unimportant. 

In large doses, arsenious acid is a virulent irritant poison, and is 
known as such in almost all parts of the world. Yet it is stated as a 
fact by Dr. Blake, now of Saint Louis, that arsenic, which, it might 
have been presumed, would be rapidly fatal, " is so inert when intro- 
duced into the blood, that it will not speedily produce death, unless it 
is injected in quantities sufficient to directly coagulate the blood." 
"It remains" — he adds — "for future experiments to determine if this 
is owing to its being isomorphous to one of the elements of the fluids 
and solids, the phosphorous." (See vol. i., p. 94.) 

In small doses, and administered for a considerable period, arsenious 
acid modifies the condition of the fluid of the circulation, and, through 
it, of the system of nutrition, so as to remove various morbid conditions 
of the same. Hence, it falls also under another head — that of Eutro- 
phics. It is generally likewise regarded as a tonic, and all admit that 
it is an antiperiodic. Under continued use, a sensation of heat in the 
throat, oesophagus and stomach, is, at times, experienced, with nausea, 
pain of the stomach, and occasional vomiting: great languor or de- 
pression of spirits is likewise felt, with redness of the eyes, swelling of 
the eyelids, and oedema of the face : — to the last symptoms the name 
(Edema Arseniealis has been given. The practitioner ought to be on 
the watch for their supervention, as they are the first evidences of 
poisoning ; and the remedy should be discontinued, until they have 
passed away. Arsenic was probably one of the agents employed in 
the cases of slow poisoning, that have been recorded in the annals of 
turpitude and crime. 

As an antiperiodic, it has been employed in intermittents; and with 
much success. This property has been long known, and is still greatly 
prized. It succeeds, at times, when both sulphate of quinia and cin- 
chona have failed, although it is not perhaps so well adapted for the 
generality of cases as either; and even were it so, the evils that occa- 
sionally result from its use would render either of the others preferable. 
It has, however, its advantages; and a modern writer, Dr. Brown, who 
prescribed it in many hundred cases, considers it superior to cinchona, 
but inferior to sulphate of quinia. It is devoid of taste, which is an 
advantage ; and if any apprehension be entertained in regard to the 
exhibition of the bark, or its alkaloid, during the hot stage of an inter- 
mittent, it cannot apply to arsenious acid. At times, too, the acid, in 



88 SPECIAL TONICS. 

combination with other antiperiodics, is successful, when neither, singly, 
has arrested the disease. 

Like sulphate of quinia, arsenious acid has exhibited its powers in 
other diseases characterized by regular periodicity, as in hemicrania, 
and various other forms of neuralgia. In epilepsy, it has not been as 
efficacious as some of the metallic tonics already considered ; but in 
chorea, in the practice of some, its beneficial agency has been signal. 

The dose in substance is from one-sixteenth to one-eighth of a grain 
in the form of pill. Care must, of course, be taken that the arsenic is 
well divided. With this view, one grain may be rubbed with a little 
sugar, and then sufficient crumb of bread be added ; the whole being 
well beaten before the division into sixteen or eighteen pills. Most 
commonly, it is administered in the form of Fowlers solution, — the 
preparation given below. Some, however, have believed, that they 
cannot be substituted for each other. As arsenious acid is apt to accu- 
mulate in the system, it may be well to intermit its use for a day or two 
every fortnight, or three weeks at the farthest ; and, to avoid unpleasant 
gastric symptoms, it has been advised that it should be taken when 
food is in the stomach ; but it is questionable, whether there be much 
advantage in this. Dr. Christison thinks, that dilution is a more rational 
way of preventing any unpleasant immediate action. 

LIQUOR POTASS M ARSENI'TIS, SOLUTION OF ARS'ENITE OF POTAS'SA- 
This is prepared by boiling arsenious acid and carbonate of potassa in 
distilled water, until the acid is wholly dissolved. To the solution, when 
cold, a little sphit of lavender is added to give it colour and flavour, by 
which it may be distinguished from water. The preparation was first 
proposed by Dr. Fowler, and hence was called after him Fowler's so- 
lution. It also long bore the name of Tasteless Ague Drop. Each 
fluidrachm of the officinal preparation of the Pharmacopoeia of the 
United States contains half a grain of arsenious acid. The usual dose 
is eight or ten drops two or three times a day. It has been prescribed, 
however, in larger quantities without any manifest inconvenience. 

62. SALIX.— WILLOW. 

The only species of willow, introduced into the Pharmacopoeia of the 
United States, is Salix alba or white willow; Sex. Syst. Dicecia 
Diandria ; Nat. Orb. Salicaceae. This species is received, also, by the 
London College ; whilst the Edinburgh acknowledges Salix caprea or 
round-leaved willow ; and the Dublin Salix fragilis or crack willow. 
Dr. Pereira-has suggested, that to judge of the therapeutical value of 
different species of salix, the best practical rule to follow would be, — 
to select those whose barks possess great bitterness combined w T ith 
astringency ; and the same rule is applicable to the species, that are 
native in this country, and are probably of as much therapeutical value 
as Salix alba, which is indigenous in Europe ; but has been introduced 
here and is now very common ; flowering in April and May. In the 
dried state, the bark is usually quilled, and devoid of odour. It has a 



PIPERINA 



89 



bitter and astringent taste ; and yields its virtues to water and alcohol. 
It is in the secondary list of the Pharmacopoeia of the United States. 

Willow bark possesses similar virtues to Cornus Florida, and, like it, 
has been employed not only as an ordinary tonic but as an antiperiodic. 
It may be given in the same doses and cases as cinchona. It has 
acquired more attention in consequence of the separation of its active 
principle, called 

Sai/icin. This is prepared by preference from Salix helix, but it is 
found, likewise, in the barks of other willows — as Salix alba, S. vitel- 
line!, S. purpurea, S. Lambertiana, S. pentandra, S. polyandra, S. 
frugilis, S. viminalis, &c, and in the leaves and barks of several species 
of poplar — Populus tremulus, P. tremulo'ides, P. alba, and P. Grceca. 
The various modes of preparing it are given by the author in another 
work, (New Remedies, 5th edit. p. 550, Philad. 1846). It crystallizes 
in very fine silky masses of white crystals, which have the appearance 
of mother of pearl. It is devoid of smell ; but has a strong enduring 
bitter taste, with a balsamic flavour like that of the bark of the willow. 
One hundred parts of cold water dissolve six parts of it. It is more 
soluble in warm water, and, likewise, in alcohol; but is not soluble 
either in ether or the essential oils. It has no alkaline reaction. 

Salicin has been largely employed in intermittent fever, and with very 
successful results. Sentiments, however, in regard to its antiperiodic 
powers are discrepant ; some placing it far beneath the sulphate of qui- 
nia, others above it. By general consent, however, it is regarded as 
inferior. Comparative trials were directed a few years ago by Surgeon- 
general Lawson ; but the author has not seen the results. Such an in- 
vestigation was made by Dr. Fenner, of New Orleans, who arrived at 
the conclusion, that " the average amount of quinia required to cure 
twenty cases of intermittent fever, and costing twenty-five cents, is 
fully three times as efficacious as the average amount of salicin required 
in a like number of cases, and costing seventy-five cents." Dr. Fen- 
ner's report has all the appearance of accurate and impartial observation. 

The dose as an antiperiodic is four or five grains, repeated according 
to circumstances: as a tonic, it is less. 

63. PIPERI'NA.— PIP'ERIN. 

Black pepper, infused in whisky, has long been a popular remedy, 
with sailors, in intermittents ; and it is probable, that its virtues, in 
such cases, are dependent both upon piperin, and acrid oil, which the 
pepper contains. Piperin exists in black, white, and long pepper, and 
also in cubebs. At first it was regarded as a vegetable alkali ; but M. 
Pelletier subsequently analyzed it carefully, and showed that it was not 
such, but bore considerable analogy to resins, and was of a peculiar 
nature. He farther denied it all medicinal activity ; but in this he was 
mistaken. He spoke as a pharmacien, not as a therapeutist. 

When quite pure, piperin forms colourless rhombic prisms, which are 
insoluble in water, but soluble in alcohol and ether. It is generally de- 



90 



SPECIAL TONICS. 



scribed as bland, when quite pure ; but Dr. Christison states, that the 
purest he has been able to obtain, was as acrid as that which was 
brownish ; and emitted an intensely irritating vapour when thrown on a 
heated iron plate. 

» 
Piperin has been given largely by the Italian physicians, especially in 
intermittent fever ; and, they affirm, with very great success. Opinions, 
however, in regard to it, have been discrepant. It may be prescribed 
in the same cases as sulphate of quinia, in the dose of from gr. ij to vj 
and more, made into pill with extract of gentian, and repeated accord- 
ing to circumstances. 



64. CORNUS FLOR'IDA.— DOGWOOD. 

The bark of Cornus Florida, Dogwood, Sex. Syst. Tetrandria 
Monogynia ; Nat. Ord. Caprifoliacese — an indigenous tree, which 
flourishes in every part of the United States — is officinal in the Phar- 
macopoeia of the United States. Dogwood is a well known ornament 

of the American forests, 
by reason of the multi- 
tude of large white flow- 
ers, which it sends forth 



in May. The bark is 
obtained from every part 
of the tree ; but that of 
the root is preferred. 

As met with in the 
shops, it is in pieces of 
various sizes, common- 
ly more or less rolled; 
and, at times, covered 
with a fawn-coloured 
epidermis. Its smell is 
feeble ; taste bitter and 
astringent. At one time, 
it was stated to contain 
a peculiar principle, to 
which the name .Cor- 
nine was given ; but if 
such exist, it is not used. 
Like other bitter barks, 
it yields its virtues to 
water and to alcohol. 

Cornus Florida was 
at one time much given 
comus Florida. as an antiperiodic, and 

doubtless still is in many 
parts of the country. Like most of these agents, however, it has fallen 
into comparative disuse since the introduction of sulphate of quinia. 




HIPPOCASTANUM. 91 

It possesses tonic virtues, and may be given in all cases in which cin- 
chona is indicated, although far inferior to it in efficacy. In intermit- 
tent fever, the powder may be prescribed in the dose of a drachm, 
repeated so that an ounce or more may be taken during the apyrexia. 
As a tonic, it may be given in infusion: — {Corniis Florid. %y, Jlquae 
bullient. Oj.) The decoction is the only officinal preparation. 

: DECOCTUM COR'NUS FLORID M, DECOCTION OF DOGWOOD. ( Corniis Florid. 
^j ; Jlquce bullient. Oj.) The dose, as a tonic, is f.5iss to f.^ij and 
more. 

65. Cornus Circina'ta, Round-leaved Dogwood ; and — 66. Cor- 
nus Seric^ea, Swamp Dogwood, both indigenous in the United States, 
yield barks which are officinal in the secondary list of the Pharmaco- 
poeia of the United States; and which possess the same virtues, and are 
inservient to the same uses as the bark of Cornus Florida. 

67. LIRIODEN'DRON.— TULIP TREE BARK. 

Liriodendron Tulipifera, Tulip tree or Poplar ; Sex. Syst. Polyandria 
Polygnia ; Nat. Ord. Magnoliacese, is a well known boast of the 
American forest, — bearing, in May, numerous flowers, which have a 
resemblance to the tulip ; and have hence obtained 
for it one of its popular names. The bark is offi- Fi s- 142. 

cinal in the secondary list of the Pharmacopoeia of 
the United States. In the shops, it is in pieces of 
various sizes ; of a yellowish white colour, and 
easily broken. That obtained from the root is 
generally preferred. Its taste is aromatic, pungent 
and bitter, — properties which are imparted to water 
and alcohol. The aromatic and pungent property, 
however, is injured by decoction. It was sepa- 
rated by the author's late friend — Professor Em- 
met, of the University of Virginia — who called it 
Liriodendrine. It does not resemble quinia in its 
chemical characters. It unites with neither alkalies 
nor acids ; and appears to hold a place between Liriodendron tuiipifera. 
the resins and essential oils. It has not been used in medicine. 

Tulip tree bark has been prescribed under the same circumstances as 
that of dogwood ; its dose in the apyrexia of intermittents being, in pow- 
der, 5j. As an ordinary tonic, it maybe prescribed in infusion. (Lirio- 
dendr. I] ; Jlqua bullient. Oj. Dose, f.giss to f.|iij.) The Pharma- 
copoeia of the United States contains no officinal preparation of it. 

68. HIPPOCASTANUM.— HORSECHESTNUT. 

JEsculus Hippocastanum, Horsechestnut, Buckeye ; Sex. Syst. Hep- 
tandria Monogynia ; Nat. Ord. Hippocastaneae, is indigenous in the 
mountainous regions of Asia Minor and Persia, and grows in this coun- 




92 



SPECIAL TONICS. 






Fig. 143. 



try as well as in Europe. The bark is the part employed in medicine : 
it has an astringent bitter taste, and contains a considerable quantity of 
tannic acid. A peculiar principle, JEsculine y is said to have been dis- 
covered in it ; but this has been contested. 

The bark has been long used 
as an astringent; and in modern 
times has been brought forward 
as a substitute for cinchona. It 
would seem to accord most in 
properties with willow bark, — 
the latter appearing, however, to 
be more effective, and to agree 
better with the digestive organs. 
It was much used during the 
wars of Napoleon, when cincho- 
na was scarce. It has, likewise, 
been administered as an astrin- 
gent tonic when such an agent 
was indicated. Many of the 
European pharmacopoeias have 
an aqueous extract of the bark, 
which is said to agree better with 
the stomach than the powder or 
decoction. 

The following Factitious Pow- 
der of Bark is contained in the 
Prussian Pharmacopoeia : — R. 
Cort. Hippocast., Cort. Salicis, 
Cort. Gentian, rubr., Calam. 
Aromat.y Caryophyll. aa. 3ij. — M. In this preparation, the willow— as 
already remarked — has medical virtues analogous to those of horse- 
chestnut bark; gentian is a simple bitter; and calamus and cloves are 
excitants. Hufeland affirms, that this powder is an adequate substitute 
for cinchona in three cases in four. 




jEsculus hippocastanum. 
a. Flower, b. Fruit. 



69. NARCOTI'NA.— NAR'COTIN. 

Narcotin is obtained either from the aqueous extract of opium of the 
shops by means of ether, which dissolves only the narcotin, and con- 
sequently requires only to be evaporated to obtain it; or from crude 
opium, which has been exhausted by cold water. Narcotin crystallizes 
in white needles; is devoid of taste and smell ; neutral ; and, of course, 
very soluble in ether. It is also soluble in hot alcohol. 

As elsewhere remarked, narcotin was supposed to be the excitant 
property of opium ; morphia the sedative ; but subsequent researches 
have not established this. 

Although it is insipid, its salts are intensely bitter. The sulphate and 
the muriate have been used as antiperiodics, — the latter with great suc- 
cess. The following is the mode of preparing the latter salt, which 
was employed by Dr. O'Shaughnessy in India as a substitute for quinia. 



CETRARINA. 93 

Take of Bengal opium, two pounds ; alcohol, twenty pounds. Rub 
them in a large mortar, adding the alcohol gradually until the opium is 
robbed of its soluble portions. The solution is then decanted, and the 
insoluble part pressed. To the alcoholic solution as much ammonia is 
added as renders the liquid slightly turbid. Fifteen pounds of the 
alcohol are then distilled from a common alembic ; and the fluid in the 
still is drawn ofT, and set aside to cool. On cooling, amass of coloured 
crystals is deposited, which is composed of narcotin, meconate of am- 
monia and resin. This is washed with water, which dissolves the 
meconate ; and afterwards with a quart, of water and a drachm of mu- 
riatic acid, which dissolves the narcotin and leaves the resin. The 
solution is then filtered and evaporated to dryness. 

The muriate, thus formed, is a transparent, resinous mass, of a rosy 
colour, and brittle vitreous texture. It is very soluble in water, and 
alcohol; and intensely bitter. It has been prescribed largely in India 
in intermittents. Sixty cases were treated by Dr. O'Shaughnessy, of 
which all but two were successful ; and the same gentleman refers to 
one hundred more, which had been treated by his pupils and acquaint- 
ances, with perfect success, by the same remedy. 

70. PHLORIDZI'NA.— PHLOR'IDZIN. 

The bitter principle, to which the name Phloridzin has been given, 
exists in the bark of both the trunk and the root of the apple, pear, 
cherry and plum tree. It is obtained by boiling the fresh bark of the 
root of the apple tree in sufficient water to cover the bark ; decanting 
the decoction, and boiling again with a little more water. On uniting 
the decoctions, and permitting them to stand for twenty-four hours, the 
phloridzin is deposited in granular crystals. One thousand parts of 
water, at a temperature from 32° to 71°, only dissolve about one part; 
but at from 71° to 212°, water dissolves it in all proportions. It is also 
very soluble in alcohol at ordinary temperatures. It has no action on 
test papers. 

Ten to fourteen grains of phloridzin have occasionally arrested an 
intermittent after sulphate of quinia had failed. The testimony of many 
observers is, indeed, in favour of its antiperiodic virtues. It may be 
given, made into pill with extract of gentian as an excipient. It has 
also been administered in enema. 

71. CETRARI'NA.— CET'RARIN. 

Cetrarin is obtained from Cetraria Islandica, (i. 252,) by boiling 
coarsely powdered cetraria in four parts of alcohol ; filtering the solu- 
tion when tepid ; acidulating with diluted muriatic acid ; diluting with 
three times its volume of water, and allowing crystals to form slowly. 
The crystals may subsequently be purified Pure cetrarin which— it 
has been recently affirmed, is a compound of three distinct substances- 
is of a white colour, and intensely bitter taste. Its best solvent is alco- 
hol. It is very sparingly soluble in water, hot or cold. The acids do 



94 ASTRINGENTS. 

not unite with it. From a pound of cetraria, 135 grains of pure cetra- 
rin were obtained. 

It has been given as an antiperiodic in intermittents, in the dose of 
two grains every two hours during the apyrexia ; but it has not been 
used in this country. It has been suggested, that an alcoholic solution 
should be prescribed in place of the cetrarin itself; and it may act 
more speedily, for the same reason that a solution of the sulphate of 
quinia is more effective than the salt in substance. 

72. BEBEERI'NA.— BEBEERINE. 

In the year 1843, Dr. Douglas Maclagan read a paper on the chemical 
history of the Bebeeru Tree, of the species Nectandra, — N. Rodisei; 
Sex. Syst. Dodecandria Monogynia ; Nat. Family, Lauracese, which 
grows in British Guiana. The bark and seeds yield two alkaline bodies, 
which he calls bebeerine and sipeerine from the Indian and Dutch names 
of the tree. The sulphate of the former has been proposed as a substi- 
tute for sulphate of quinia; with which, indeed, it appears to possess 
analogous properties. Of late years, in Edinburgh, a great improve- 
ment has been made in its manufacture, so that it is now prepared at less 
than half the price of the sulphate of quinia. (Christison.) From a 
scruple to a drachm between the paroxysms of a tertian is generally 
sufficient to arrest the intermittent. Its antiperiodic virtues are very 
decided. According to Dr. Maclagan, a secret preparation, sold under 
the name of " Warburg's Fever Drops " appeared, on chemical exami- 
nation, to be a tincture of bebeeria, made, probably, from the seeds of 
the bebeeru tree. It is doubtful, however, whether this is the case. 



III. ASTRIN'GENTS. 

Synon. Constringentia, contrahentia, stegnotica, syncrilica, adstrictoria. 

Definition of astringents— Tannic acid the great vegetable astringent principle— Their 
modus operandi — Act best on parts with which they come in contact— Bad effects of 
astringents— Indirect astringents— Therapeutical application— In fevers, inflammations, 
hemorrhages, &c. — Astringents often used by the surgeon — Styptics— Special astringents. 

Astringents are defined, by Dr. A. T. Thomson, to be substances, 
which produce contraction and condensation of the muscular tissue; 
but in his table of classification, he ranges them amongst vital agents, 
that operate on the "muscular and sanguiferous systems." There is no 
reason, however, why their operation should be restricted to those sys- 
tems. They affect also, as remarked by the Messrs. SchrofF, the skin, 
mucous membranes, cellular tissue, and the glandular, and parenchy- 
matous organs; and a better definition would be, simply, "agents, that 
occasion contraction, and condensation of the tissues." 

The inconsistency in the two definitions by Dr. Thomson, given 
above, is much less, however, than that developed in a subsequent part 
of his section on astringents, where he proceeds to give his theory on 



ASTRINGENTS. 95 

the nature of astringency. By a reference to his table of classification, 
(vol. i., p. 97,) it will be found, that he separates Excitants, Sedatives, 
Refrigerants, Narcotics, and Antispasmodics — which operate directly 
on the nervous system — from Tonics, and Astringents, which operate 
on the muscular and sanguiferous systems; yet, the development of his 
theory, regarding the action of the last class, shows convincingly, that 
he ought to have referred it to the division, which comprises the various 
agents that act directly on the nervous system. " I. conceive it to be 
a power," he remarks, " which, through the medium of the motor 
nerves, acts on the insensible contractility of the muscular fibril, pro- 
ducing a closer approximation of their component particles ; and, by 
thus augmenting their cohesion, causing a greater and more permanent 
density, and a corresponding vigour in the muscular tissue. This action 
differs from ordinary muscular contraction, in not being dependent on 
the nerves of sensation ; and, consequently, in not being the result of 
any communication with the sensorium ; in not exhausting excitability; 
and in the permanency, of its effects. The movements constituting 
muscular contraction are the consequence of impressions conveyed to 
the brain through the sensitive nerves, and thence to the motor nerves 
of the part: the contractions following the application of astringents 
are the result of direct impressions on the motor nerves themselves, 
altogether unconnected with those of sensation." 

It is doubtful, whether any such direct agency on the nerves be 
exerted by astringents. It is more probable, that the primary effect is 
upon the intimate tissues of organs, as astringents are capable of pro- 
ducing condensation and contraction in parts that are deprived of the 
vital influence; and, although much has been said against the idea, that 
anything like tanning can can be effected upon the living tissues by 
the operation of this class of medicinal agents, the explanation does 
not appear to the author as wide of the mark as it has been conceived 
to be by many. The vital influence prevents the precise chemical 
changes from being effected, — the requisite union of the gelatin of the 
skin, for example, with the tannic acid of oak bark, — but it does not 
prevent the condensation and corrugation of tissue, something similar 
to which is produced in the dead fibre, as well as in vegetables — 
organized bodies that are devoid of nerves. 

Astringents may be used internally, either for the purpose of acting 
upon the parts with which they come in contact, or indirectly on distant 
parts; or externally, particularly with the view of arresting hemorrhage, 
—when they are called styptics; and a difference has been made amongst 
these, according as they act chemically or mechanically ;— the chemical 
styptics coagulating the blood exuding from the part, and, at the same 
time, stimulating the tissues to contraction ; whilst the mechanical — as 
felt, agaric, lint, &c. — detain the blood in their meshes ; or absorb it, 
until it coagulates, and thus arrest the hemorrhage. 

Astringents can be readily detected by the taste. They convey a 
sense of roughness to the palate, which cannot be mistaken ; but which 
is more marked in some substances than in others. It is thus, that the 
mineral acids,— alum, and the various metallic salts, and vegetables, — 
arejeadily detected as astringents. 



96 ASTRINGENTS. 

The vegetable kingdom furnishes largely to this division of therapeu- 
tical agents ; and the property, on which their virtues are mainly de- 
pendent, is tannic acid — the principium scytodephicum or GerbestofT 
of the Germans. This is associated with gallic acid in galls, kraraeria, 
tormentilla, uva ursi, &c. 

The action of astringents, when taken internally, may be altogether 
local on the tissues with which they come in contact ; or the excitant 
effect, — for it is excitant, — may be communicated to other parts of 
the frame, as in the case of tonics ; so that the action of organs at a 
distance may be modified ; and immoderate discharges from them be, 
in this manner, arrested. When such is the case, the hemorrhage 
may be controlled, in consequence of the simple tonic influence exerted 
by the astringent ; for it is not easy to see how the effect of the astrin- 
gent itself can be extended beyond the part which it immediately 
touches ; — or, the astringent principle may pass into the mass of blood 
by absorption ; and come in contact with the vessels whence the 
immoderate discharge is proceeding. This may be the case, but it is 
difficult to conceive, that a small dose of an astringent substance, 
received into the blood, can proceed to the seat of an undue flow, and 
there act in sufficient concentration to produce any manifest astringent 
agency ; yet this is the modus operandi according to many writers. 
Dr. Thomson, indeed, asserts, that, " without such a supposition, 
we should not be able to explain the manner, in which they [astrin- 
gents] act in stopping hemorrhage, when internally administered, espe- 
cially when taken into the stomach;" and he adds: — "Mr. Brodie 
gave a patient, who had a frightful hemorrhage from the prostate 
gland, and in whom all other remedies had failed, a dose of Rus- 
pini's styptic, and repeated the dose twice in the course of twelve 
hours. About half an hour after the first dose was taken, the bleeding 
ceased, and it never recurred." This styptic is said to consist of gallic 
acid, a small quantity of sulphate of zinc, and opium, dissolved in a 
mixture of alcohol and rose water ; but, as the quantity of sulphate of 
zinc, and opium, appears too small to influence the medicine, a simple 
solution of gallic acid in diluted alcohol, it has been conceived, will 
answer all the purposes of the expensive nostrum. The above case, 
however, is insufficient to establish the fact of absorption ; and, without 
meaning to deny, that the styptic in it did exert agency in arresting the 
hemorrhage, the author does not think, that a solitary instance of the 
post hoc is sufficient to establish the propter hoc. Dr. Thomson, indeed, 
himself admits, that he has not witnessed its influence, as an internal or 
general astringent ; although he has frequently observed its power in 
checking the most obstinate bleedings from leech bites in children, after 
all other means had failed. 

Another mode in which astringents may act, in certain cases, is by 
passing into the mass of blood, and increasing the tendency to coagu- 
lation of that fluid. 

It is manifest, that in all increased discharges, which occur from parts 
that can only be reached through the medium of the circulation, no 
signal advantage can be expected from the administration of astringents; 
on the other hand, where they can come into immediate contact with 



MODUS OPERANDI. 97 

the seat of the disease, they may be more relied upon. Accordingly, 
in hsematemesis and epistaxis, and in chronic diarrhoea, and dysentery, 
their action is more marked than in haemoptysis, immoderate flow of 
the menses, or leucorrhcEa; inasmuch as, when taken internally, they 
can only act on the lungs, uterus or vagina, either by the impression 
they make on the general system through the nerves of the stomach, or 
by being taken into the circulation. 

Under the view, everywhere embraced by Dr. Chapman, of Philadel- 
phia, in his " Elements of Therapeutics ," that the vital action of parts re- 
sists anything like chemical change ; — that " so long as vitality endures, 
every chemical action or combination is repelled by powers and re- 
sources peculiar to the animated condition," the modus operandi of 
astringents becomes a weighty stumbling block. "Nevertheless," he 
remarks, " there would seem, at the first view, to be a class of articles 
endowed with the property of corrugating or contracting the living 
fibre. This is especially evinced by the sensation, which they impress 
upon the tongue and fauces; and, perhaps, still more conspicuously by 
their efficacy in restraining hemorrhages from wounds. Yet how they 
operate has never been very intelligibly explained. Their effects are 
ascribed altogether by Darwin to the power of promoting absorption. 
Whether they have such a property is exceedingly doubtful. Con- 
ceding it to them, however, it will not, in the slightest degree, account 
for their suppression of hemorrhage." 

This is all that Dr. Chapman says of the general modus operandi of 
astringents. He offers no view of his own; and, indeed, appears to 
doubt, whether there be any agents endowed with the property of corru- 
gating or contracting the living fibre ; inasmuch as he says, there would 
"seem, at the first view," to be a class of such articles, — leaving the 
inference to be deduced, that farther examination would exhibit its 
non-existence. We can have no more doubts, however, of the astrin- 
gent agency of such a class of substances, — modifying the condition of 
the living fibre, in the mode mentioned, — than we have of the reality 
of cathartics, emetics, or narcotics. 

In all cases where profuse discharges have to be checked, it is im- 
portant to inquire, whether they be accompanied by unusual activity of 
vessels, or, in other words, of the kind generally regarded and denomi- 
nated active, — or whether they be passive. Some have denied, that 
there can be such a state as passive hemorrhage, but it can be readily 
understood, that there may be a condition of vessels in which then- 
texture is so loosened as to permit the blood to transude with facility 
from within to without; and, accompanying, or not, this condition, 
there may be a degree of fluidity and impoverishment of the blood, 
that may adapt it for a more ready transudation than when it contains 
more fibrin, and red corpuscles. The author attended a young female, 
who, in consequence of hyperemia of the encephalon, had been bled 
every fortnight for several months, to the extent of a quart or more ; 
and in whom it was an object of moment to break in upon the habit 
thus induced. Her whole appearance was anaemic. She was pale, 
apparently almost exanguious ; the pulse was small, indicating the pre- 
sence of but little blood in the vessels ; yet at the usual interval of a 

Vol. II.— 7 



98 ASTRINGENTS. 

fortnight, signs of augmented action in the vessels of the head super- 
vened ; and it was for a time esteemed indispensable to repeat the 
blood-letting. The author's endeavour was to gradually break in upon 
this habit ; — to cup her, when the encephalic symptoms made their ap- 
pearance ; and, by revellents, to direct the afflux of blood elsewhere. 
Occasionally, however, it was necessary, in consequence of the super- 
vention of delirium, to take away a pint of blood, and this was largely 
composed of serum, — affording .the strongest proof of that form of 
hyperemia, which is characterized by impoverishment and deficiency 
of the circulating fluid. The original mischief was probably in the 
great nervous centres ; and blood-letting was doubtless, in the first in- 
stance, appropriate ; but the frequent repetition of it was well adapted 
to lay the foundation for periodical irregularities of circulation, like 
those under which she was suffering, and from which she ultimately 
recovered under the plan recommended by Ihe author. The case is an 
elucidation of the fact — often referred to in these pages — that hyperemia 
may be induced by agencies, that are regarded as best adapted for its 
removal, provided such agencies be pushed to an inordinate extent ; 
and it is an additional evidence in favour of the importance of attend- 
ing to the state of the nervous system, under whose influence hyperaemic 
affections are often developed ; and where the indication of cure is less 
to withdraw the circulatory fluid than to allay the nervous irritability, 
which gives occasion to the excited state of capillary vessels, that con- 
stitutes most of the varieties of hyperemia. 

From what has been said it obviously follows, that in acute inflam- 
mations of mucous membranes, accompanied by increased discharges, 
powerful astringents may be — to say the least — of doubtful propriety ; 
whilst in chronic inflammations, where debility of capillaries exists they 
may, like excitants, be the best class of agents that could be had re- 
course to. Care, however, has always to be taken with regard to their 
strength. M. Broussais has properly remarked, in one of his propositions, 
that " vegetables, which are astringent in small doses, produce gastro- 
enteritis when taken in large doses." But this does not apply to the 
gastro-enteric mucous membrane solely. The sudden application of a 
powerful astringent condenses and corrugates the mucous tissue, so that 
the calibre of the vessels is diminished below the natural ; the circulation 
through them is consequently obstructed ; and hence supervenes in- 
creased action of the vessels that are continuous with the constricted ca- 
pillaries. In another proposition, M. Broussais affirms, that " the mineral 
astringents, the sulphates of alumina, of zinc, and of iron, act nearly 
in the same manner as the preparations of lead, except that the latter 
produce a truly deleterious effect on the nervous system :" " the primary 
action of all," he adds, " is stimulating ; they all contract the fibres, 
and afterwards diminish the innervation." He asserts, too that when 
astringents are applied so as to arrest the " serous elimination" of the 
skin, an internal exhalent action succeeds ; and, as an instance of this, 
he adduces dropsies, that immediately follow the application of an as- 
tringent, which has repelled itch, tetters, and even acute inflammation 
— as erysipelas. " Similar dropsies have been sometimes induced by 
frictions with ointments containing sulphate of alumina, sulphuret of 



MODUS OPERANDI. 99 

potassa, or baths impregnated with corrosive sublimate, employed for 
the cure of prurigo or obstinate itch." 

Without meaning to deny, that where an accustomed irritation has 
been suddenly repressed, it may be transferred elsewhere ; and that 
where a long established drain is arrested, exhalation may be produced 
in other parts of the system, — it is proper to observe, that the author 
has never witnessed dropsy induced in the manner referred to by 
M. Broussais ; nor is he disposed to admit, that it could readily happen. 
The surface, in a case of tetter, is so small, and the elimination effected 
from the skin of the part so trifling, that it appears improbable, that any 
augmentation of internal exhalation could be induced to such an extent 
as to give rise to dropsy, by astringent or other agents employed for the 
removal of the cutaneous eruption. 

The astringent medication is considered, by many writers, under the 
head of tonics ; and some of the substances in the catalogue of the 
Materia Medica eminently possess tonic or corroborant virtues. Such 
is the case with cinchona ; yet its chief virtues are not dependent upon 
this astringency, as quinia possesses none of it. It is obvious, that the 
efficacy of astringents may vary according to the principles that are 
united with them ; and this may give occasion to the exertion of some 
choice to adapt them to particular conditions of disease. 

The most potent of the vegetable astringents are indebted for their 
properties to the tannic acid they contain ; but many others have a bitter 
or an aromatic principle associated with the astringency, and have 
therefore, been termed respectively, by some of the Germans, amaro- 
adstringentia, and balsamico-adstringentia , — -as salix, hippocastanum, 
juglans regia, the caryophyllatse, and especially the cinchona?, &c. 

Thus far the author has referred only to the action of direct astrin- 
gents: profuse evacuations may, however, be connected with different 
states of the living system ; so that agents, possessed of no astringent 
properties, may yet check them ; or produce an astringent operation, 
indirectly. Hence we have ' direct' and * indirect' astringents, as we 
have direct and indirect tonics. Opium, for example, by allaying the 
augmented peristole in diarrhoea, may exert an action of astringency, 
and diminish the number of discharges ; and, accordingly, it is often 
had recourse to in such cases. Again, the increased discharges of dysen- 
tery are induced by an inflammatory condition of the mucous coat of 
the intestines. Bleeding, therefore, by allaying this inflammation ; and 
castor oil, given occasionally so as to gently remove the morbid secre- 
tions, by taking away the cause may check the effects. A predominance 
of acidity in early infancy lays the foundation to many of the bowel 
complaints which are so common at that age, and keeps them up when 
once established. A proper antacid, by neutralizing the acid, takes away 
the cause, and thus becomes an indirect astringent. In active hemor- 
rhage, where a condition closely allied to inflammation exists, the flow 
of blood is arrested by antiphlogistic remedies, which thus become 
astringents ; and, lastly, cold is one of the most valuable of the indirect 
astringents which we possess, especially in hemorrhages of the active 
kind. Much of this effect is, doubtless, produced by its temperant, 



100 ASTRINGENTS. 

antiphlogistic or refrigerant operation, which — it will be seen hereafter 

is manifest. Where, however, cold — as in the form of ice or iced 

water ca n be made to come in contact with the bleeding part, it pro- 
duces condensation and corrugation of the tissues ; diminished calibre 
of the vessels ; and coagulation of the exuding fluid, in the same 
manner as substances that belong to the class of direct astringents. 
When properly used, it is really one of the most valuable astringents 
that we possess. 

Therapeutical application of .Astringents. 

Fever. — With regard to the therapeutical application of an astringent 
medication, it need scarcely be remarked, that it is inadmissible in 
fevers, unless they should be complicated, in the latter stages, with 
symptoms especially indicating its employment. In intermittens, they 
have been frequently used, and often with decided advantage. Gene- 
rally, however, the astringents that have been employed in such cases, 
have possessed other properties on which their efficacy was dependent. 
The author has already observed, that the different varieties of cinchona 
contain a principle, which is not astringent, along with another that is; 
yet the former exerts all, or almost all, the astringent power, which the 
bark in substance is capable of exerting. At times, however, we meet 
with cases, in which the bark in substance succeeds, when quinia has 
failed ; and it is not improbable, that in such cases the astringent pro- 
perty may aid the tonic or febrifuge in arresting the disease. 

The dynamic influence of the tonic on the body is manifestly of a 
nervous character ; and the author has attempted to show, that astrin- 
gents are capable of exerting one of a similar kind ; so that even when 
the latter are administered in an uncombined state, they may succeed 
in putting a stop to intermittents. Astringents are, however, but rarely 
employed, inasmuch as we possess valuable agents of another kind for 
effecting all that they can accomplish, and more too; but there may be 
pathological conditions, during the existence of an intermittent, which 
may demand their use ; as when the ordinary antiperiodic tonics run off 
by the bowels, or when discharges supervene, which, if allowed to per- 
sist, might be attended with injurious consequences. 

Inflammations. — During the active stage of inflammations the same 
rule applies to the administration of astringents as to that of excitants. 
Although occasionally employed with success during the violence of 
external inflammations, or those of the dermoid tissue, their efficacy is 
more decided after the violence of the inflammation has passed away, 
and when a state of over-distention of the extreme capillary is the chief 
pathological condition that keeps up the excited action of the vessel 
communicating with it. In some inflammations, however, their bene- 
ficial agency, like that of excitants, is manifested from the first. Such 
are inflammations of the tunica conjunctiva, of the tonsils, velum pen- 
dulum, and of parts of the mucous membrane, which admit of being 
inspected, as of that which lines the mouth and fauces ; — or which can 



GENERAL EFFECTS. 101 

be reached by them in their undiluted state, as the inflammations that 
characterize blennorrhcea or gonorrhoea, and leucorrhcea. 

In conjunctivitis, occasionally from the first, and almost always in 
what is called the catarrhal variety, after the violence of the action of the 
vessels has been somewhat got under by the employment of appropriate 
antiphlogistics, the advantage of the astringent metallic compounds, 
especially of the nitrate of silver, is often signal. As soon as it is 
dropped in solution into the eye, decomposition occurs, in consequence 
of its meeting with chloride of sodium contained in the tears. It be- 
comes converted into chloride of silver, which is recognizable by its 
while appearance ; but the constringency, exerted by it on the vessels, 
tends to restore them to their wonted calibre. 

In that sluggish variety of sore throat in which the mucous membrane 
covering the tonsils is of a diffused dusky red ; extending over the 
velum pendulum and the uvula, and giving occasion to tumefaction and 
relaxation of those parts, excitant and astringent gargles are the best 
applications that can be used. The vessels are here loosely situate in 
the parts in which they creep ; remora of the fluid circulating within 
them is consequently facilitated ; turgescence results ; and this state 
is not removed until the vessels resume their wonted calibre, — a 
result, which can be rendered more easy by the appropriate employment 
of astringents. 

In the malignant affections of the throat, which are concomitants of 
some of the forms of scarlatina, the same class of remedies is em- 
ployed as local applications ; some vegetable infusion or decoction, 
which contains tannic acid, being generally used, with or without the 
addition of one of the mineral acids. The decoction of cinchona, with 
associated sulphuric or muriatic acid, is a common combination for this 
purpose. 

In those affections, too, of the mucous membranes, which are attended 
with the formation of a pellicle or an exudation from the inflamed mu- 
cous surface, and which were first termed by Bretonneau Diphtherites, 
astringents are found to be extremely useful after the violence of action 
has been subdued, and the pellicle has formed. The most successful 
of these, again, is the nitrate of silver. When this salt is applied in 
solution to the mucous membrane of the mouth in a case of aphthae, or 
to the fauces in cases of diphtherites of the pharynx, larynx or trachea, 
the new action, induced in the part to which it is applied, is extended 
to the membrane lower down, and the most salutary agency is, at times, 
exerted. The exudation of coagulable lymph, — which the experiments 
of Schwilgue prove to correspond, in its properties, with fibrin, and 
which constitutes the false membrane in cases of diphtherites, — fre- 
quently begins on the surface of the tonsils; and thence spreads along 
the arches of the palate, and ultimately descends over the internal sur- 
face of the pharynx and oesophagus, as well as of the larynx and trachea. 
The application of a solution of nitrate of silver to the tonsils, velum 
palati, and uvula, frequently removes the albuminoid exudation ; pro- 
duces manifest relief of the symptoms ; and ultimately dispels them. 
Dr. Eberle asserts, that he has seen one instance in which this applica- 
tion was made ; and the result gave him a very favourable impression of 



q/l 



102 ASTRINGENTS, 

the practice ; but he says it must be confined to cases in which the 
fauces are found, on inspection, to present an irritated and inflamed 
condition. This is not. however, essential. The astringent effect upon 
the part of the mucous membrane with which the solution is made to 
come in contact, may be propagated by continuous sympathy to the part 
of the trachea lined by the false membrane ; a new action may be in- 
duced ; the albuminoid substance be detached, and ultimately thrown 
off, although it is obvious, that when a complete adventitious tube is 
formed in the trachea, and of course, below the rima glottidis, the nar- 
rowness of the aperture into the larynx must, in by far the majority of 
cases, render the evacuation of the adventitious tube impracticable. 
With a similar object, M. Laennec directed the inhalation or insufflation 
of very finely powdered alum— and he asserts, that it generally afforded 
great and speedy relief,— not only in tracheitis, but also in laryngitis, 
and amygdalitis. 

Hemorrhage.— The author has more than once referred to the im- 
portance of examining, in all cases of hemorrhage, whether they be 
active or passive,— characterized, that is, by polysemia, or hyperemia, 
by hypsemia or anaemia. In the former category, the use of astringents 
can in no wise be demanded. The fulness or the activity of vessels 
must be first reduced before the astringent medication can be adopted. 
In but few of the cases of hemorrhage does the blood flow from a rup- 
tured vessel. It generally passes out by diapedesis or transudation; 
and this may be of course favoured both by fulness of vessels, and by 
any causes that induce a remora of blood in them. The bleeding that 
takes place in this way has been considered as an effort of nature to re- 
lieve this condition, inasmuch as it unloads the distended vessels ; and, 
when this occurs, the plethora being reduced the hemorrhage generally 
ceases spontaneously. Of these fancied ' efforts of nature ' the author has 
already spoken ; and this has no more foundation. The fulness of ves- 
sels gives occasion to a physical transudation from within to without, 
and as this transudation removes the cause, — the effect, the hemorrhage, 
necessarily ceases. 

In the passive state of hemorrhage, where there is loosened cohesion 
of parts, often combined with anaemia, or with blood poor in fibrin and 
red particles, and rich in serum — as in sea-scurvy, and in some of the 
hemorrhages, that supervene in the worst cases of typhus, and other 
diseases of prostration, — the use of tonics and astringents is absolutely 
needed ; and if the latter can be brought into contact with the vessels 
exhaling the fluid, they occasion a condensation and corrugation of 
their parietes, so as to render transudation less easy. They are, indeed, 
the chief resource of the physician. The mineral acids, when added to 
blood out of the body, coagulate its albumen ; and it is probable, that 
they exert an analogous action, when taken as medicinal agents, in the 
cases under consideration. Their efficacy — as well as that of creasote — 
in scurvy, and in passive hemorrhage of every kind, may be greatly 
owing to their increasing the tendency of the blood to coagulate. 

Epistaxis is one of the most common varieties of hemorrhage. Ge- 
nerally it occurs in youth, and is of no consequence. There are but 



IN HEMORRHAGE. 103 

few individuals, about the age of puberty, who are not more or less 
subject to it. In such cases, it is usually an active hemorrhage, and 
does not require the use of astringents. In the evolutions, that occur at 
puberty, and some time afterwards, irregular hyperaemic determinations 
are apt to supervene ; and, as the vessels of the Schneiderian membrane 
are but loosely protected by the parts in which they creep, and there- 
fore yield more readily to any distending force, diapedesis easily takes 
place through them. The system of medication is here sufficiently 
simple. If the hemorrhage should recur repeatedly, and not be exces- 
sive, the depletion and the revulsion, excited by a dose of a saline ca- 
thartic — as sulphate of magnesia — are often enough to rectify the evil ; 
or if it should not yield to these, it frequently will to a repetition of the 
remedy along with the employment of a dry and spare diet. If much 
fluid be taken, either in cases of spontaneous hemorrhage, or where ab- 
straction of blood is recommended for the removal of disease, — owing 
to the vessels being deprived of their usual quantity of circulating fluid, 
the activity of absorption is greatly augmented ; and the drink passes 
rapidly through the coats of the vessels to make up for the loss sustained 
by the accidental or artificial hemorrhage. In this way, the same quan- 
tity of fluid may soon be in the vessels ; but it must necessarily be more 
tenuous — less rich in fibrin and red corpuscles — and the consequence 
is, that it soaks through the vessels more readily than it did in the first 
instance ; and thus a foundation is laid for future recurrence of the he- 
morrhage. This abstinence from drinks is one of the most important 
practical precepts that can be inculcated in the management of the dif- 
ferent hemorrhages. If the hemorrhage from the nose should be so 
profuse, at any one time — or if it should recur so frequently — as to 
bring on signs of hypasmia or inanition, it becomes the duty of the phy- 
sician to have recourse to the class of remedial agents, whose properties 
are now under consideration. 

It is a common custom to apply cold water to the nape of the neck, 
or a piece of cold iron — as a key ; and this simple agency often arrests 
the flow of blood from the Schneiderian membrane. This effect is pro- 
bably induced by the impression made on the nerves occasioning a 
diversion of the blood from the vessels of the membrane ; and a similar 
agency may perhaps be exerted, where mental impressions prove hae- 
mastatic ; — as in the case of charms, employed in such cases, in anti- 
quity more especially, and not wholly abandoned at the present day. 
The impression on those vessels can, of course, be only of a sympa- 
thetic character. In cases of anaemic hemorrhages, however, more 
direct applications become necessary, and recourse is had to metallic 
astringent salts, to alum, dilute sulphuric acid, and to plugging the an- 
terior or posterior nares, — to the former, or to both, as the urgency of 
the case may require. In this way, both chemical and mechanical 
styptics are brought to bear; the former coming in contact with the 
vessels whence the flow of blood proceeds ; and the latter preventing 
the escape of the blood by the anterior or posterior outlets of the nos- 
trils, and thus favouring the formation of a coagulum around the bleed- 
ing vessel. Dr. Thomson recommends the use of internal astringents, 
" as the infusion of roses [!] or of kino, or some other of the astringent 



104 ASTRINGENTS, 

vegetable substances, acidulated with diluted sulphuric acid," but much 
benefit cannot be expected from the action of substances on parts at 
such a distance from the seat of the malady. This, too, is the reason, 
why astringents are of less efficacy in haemoptysis ; which may take 
place from rupture or from diapedesis, but generally from the latter. 
Like all the other hemorrhages, too, it may be active or passive ; but it 
is not very common to meet with the latter variety, unless we regard as 
such the diapedesis that occurs when the lungs are filled, with tuber- 
cles, which is the most dangerous kind of hemorrhage from the lungs, 
inasmuch as its prognosis merges in that of pulmonary consumption, of 
which it is a symptom. The existence of tubercles interferes with the 
due circulation of the blood in the pulmonary and bronchial arteries ; 
and the consequence is, that on the application^ a slight exciting cause 
— as any unusual bodily or pulmonary exertion — a vessel gives way, or 
the blood soaks through its coats. 

The active hemorrhage, which takes place from the lungs of a person 
of sound constitution, — in no wise predisposed to phthisis, — is by no 
means of the dangerous tendency usually conceived. An accidental 
circumstance may give occasion to the hemorrhage, which may be re- 
moved by appropriate measures, and may never recur. 

Whenever haemoptysis is attended with symptoms of vascular fulness 
or activity, indirect astringents are chiefly had recourse to — as blood- 
letting, and the agents belonging to the classes of sedatives and refrige- 
rants. Little reliance is placed upon any of the articles of the materia 
medica, which are regarded as direct astringents ; for the simple reason, 
that none of them can be made to come into direct contact, except in a 
very diluted state, with the vessels that are exhaling blood. There are 
obviously — as elsewhere stated — two ways in which such articles can 
act : the one is by sympathetic influence on the affected vessels, through 
the astringent agency exerted on the stomach ; and the other by the 
astringent getting into the blood-vessels, and proceeding, commingled 
with the circulatory fluid, through the pulmonary artery to the lungs, or 
through the ramifications of the bronchial artery, if the flow proceeds 
from the latter vessel. In neither of these ways could any energetic 
action be exerted ; and hence it is, that the scientific physician trusts to 
general principles in the management of the case ; combating it by the 
agents already referred to, and by a. proper attention to the antiphlo- 
gistic regimen generally. Usually, when an individual is attacked with 
haemoptysis, the greatest alarm is felt; and, in all cases, it is expected 
that the practitioner should have recourse to blood-letting to arrest the 
flow. Such is the opinion of the vulgar; and occasionally it is that of 
the professional attendant also. This is not always, however, philoso- 
phical. Every one, who has had an opportunity of seeing many cases 
of haemoptysis, is aware, that the flow of blood may be arrested at a less 
expense of fluid, when due attention is paid to ventilation and to pos- 
ture, than when the lancet is used. A coagulum soon forms around the 
ruptured or transuding vessel, and the hemorrhage ceases. Whether 
blood-letting has to be used must depend upon other grounds :— upon 
the results of an inquiry into the state of the circulation, general and 
capillary, connected with the hemorrhage ; and if there should be signs 



IN HEMORRHAGE. 105 

of polyaamia, or of hyperemia, it ought to be unhesitatingly practised, 
otherwise the hemorrhage may recur, care being taken — as has been 
remarked of all cases of hemorrhage — not to allow too much fluid to be 
drunk, but rather advising, that a small piece of ice should be put into 
the mouth occasionally, for the purpose of allaying thirst and excite- 
ment. The author is satisfied, too, that the repeated abstraction of 
blood, when there is no sthenic condition present, may lay the founda- 
tion for hyperaemia in the lungs, as it does in other organs ; and this 
hyperemia will be more apt, under such circumstances, to affect the 
lungs, from their being, owing to a previous attack, predisposed to the 
pathological condition. 

Where haemoptysis is produced by the presence of tubercles in the 
lungs, it is, as already said, of unfavourable prognosis, because it is one 
of the precursors or concomitants of phthisis. Such cases can, of 
course, only be palliated by an attention to the general symptoms, and 
by the appropriate use of sedative and refrigerant remedies. Astrin- 
gents cannot here be employed with well founded expectation of suc- 
cess. Occasionally, too, hemorrhage from the lungs supervenes in a 
more advanced stage of phthisis, owing to the giving way of a vessel 
in the parietes of cavities in the lungs. The author has attended cases 
in which the individual was choked by the quantity suddenly discharged 
in this manner. At other times, in this disease, as well as in some of 
the more active inflammations of the pulmonary organs, especially in 
children, a copious effusion of blood suddenly takes place into the 
lungs, so as to completely prevent the air from reaching the pulmonary 
vessels; and the individual dies, owing to the pulmonary apoplexy, 
thus induced, occasioning asphyxia, or, in other words, completely pre- 
venting the requisite aeration of the blood in those organs. 

Where blood is exhaled from the vessels of the stomach, constitu- 
ting heematemesis, astringents can be employed with more advantage, 
because they come in contact with the vessels whence the hemorrhage 
proceeds. Here, however, it is of importance to inquire, whether the 
exhalation of blood may not be dependent upon obstructed circulation 
or mechanical hyperemia, in some other organ ; and if so, attention 
must be paid to the idiopathic derangement. The author has seen 
many cases of haematemesis and dropsy of the lower belly, from hyper- 
trophy of the spleen produced by residence in a malarious locality. 
As a large quantity of blood is sent to the spleen, this state of the vis- 
cus prevents the free circulation of blood through it ; the consequence 
is turgescence of vessels, which gives occasion to transudation of the 
watery portion into the cavity of the abdomen so as to produce ascites, 
and an engorgement of the vessels of the neighbouring organ — the 
stomach — ending in hemorrhage by diapedesis. 

It is not, however, the organs in the vicinity of any infarcted or in- 
durated viscus, that are alone liable to be the seat of hemorrhage. If 
the circulation be impeded in any viscus, foundation is laid for irregu- 
larity of circulation ; and under this irregularity, vessels may give way, 
or admit of transudation in parts that are at a considerable distance 
from the organ, whose diseased condition is the cause of the phenomena. 
Thus, epistaxis is often symptomatic of visceral infarction ; and the 



106 ASTRINGENTS. 



same hemorrhage, or haemoptysis, or haematemesis may be established 
where the uterine functions are not properly accomplished. 

The same remarks are applicable to the hemorrhagic discharges from 
the intestinal canal, which constitute one of the forms of melaena. The 
lower the seat of ihe hemorrhage, the more mixed is the astringent 
before it reaches the diseased part ; and, consequently, the less effica- 
cious. Generally, in ordinary cases, of both haematemesis and melaena, 
the author has found a combination of sulphuric acid with one of the 
alkaline or earthy sulphates, forming a supersulphate, well adapted for 
fulfilling every object of the astringent medication, where this is de- 
manded ; or metallic or other astringents may be used, under the general 
precautions previously inculcated. 

In cases of what are termed open hemorrhoids, or of hemorrhage 
from the rectum, astringent remedies may be made to come into imme- 
diate contact with the seat of the hemorrhage by injection. The use of 
gently astringent or stimulating lotions, and of laxatives, to prevent irri- 
tation from indurated faeces, is more beneficial than any other mode of 
treatment. Occasionally it happens, that the hemorrhage is so alarm- 
ingly profuse as to require the employment of the most powerful astrin- 
gents, — of the mineral or vegetable kingdoms, and even the actual 
cautery. These, however, should never be used of such strength as to 
condense and corrugate the parts so much as to endanger the super- 
vention of inflammation. 

Haeraaturia, or hemorrhage from the urinary organs, is a variety not 
directly under the control of astringents. No substance of this class 
can come in contact with the seat of the mischief, until it has passed 
into the mass of blood, and been separated by the kidneys. How 
small, consequently, must be the quantity of the astringent taken into 
the stomach, which can act at any one time upon the surface affected 
with hemorrhage. The best mode of managing such cases is to treat 
them on general principles ; — by perfect quietude ; avoiding all irrita- 
tion ; and, if there be excitement, reducing the quantity of the circula- 
ting fluid ; but if, on the other hand, there be want of tone, adminis- 
tering substances belonging to the class of tonics, or of excitants proper. 
The author does not know, that, in these cases, he has observed any 
very marked advantage from the use of astringents, except from their 
tonic agency. Improvement has occasionally followed the employment 
of some of the metallic and vegetable astringents ; but it has been pro- 
duced, apparently, by the general effect, not by any direct astringent 
action having been exerted on the vessels of the urinary organs ; for, 
even in those cases in which a mineral astringent can be detected in 
the urine, its quantity, at any one moment, in the urine distilling from 
the kidneys', must be too small to exert any sanative influence. Dr. 
Thomson, who has unbounded faith, and, perhaps, credulity on many 
points of therapeutics, as connected with the effect of particular medi- 
caments, places great reliance on the use of certain astringents in 
hemorrhages from the urinary organs. " Haematuria, or bleeding from 
the bladder," he says, "is generally depending upon some organic* 
affection of the urinary organs ; but in attending to the primary disease, 
much immediate advantage is derived from the use of astringents. It 



IN UTERINE HEMORRHAGE. 107 

was in a case of this kind that Mr. Brodie administered Ruspini's styp- 
tic with so much seeming advantage ; and I have seen great benefit, in 
similar cases, from the use of the uva ursi, which appears to pass unal- 
tered through the kidneys. Since the discovery which I have made of 
the composition of Ruspini's styptic, I am disposed to propose a com- 
bination of gallic acid with an infusion of the leaves of uva ursi, 
obtained by rubbing them in cold water." It may be remarked, on 
this passage, that, like many other articles of the materia medica, uva 
ursi has been extolled for virtues which it by no means possesses ; and 
already it has, in the opinion of many of its former supporters, sunk to 
the proper level above which it ought never to have been elevated. It 
was formerly proposed as a remedy for calculous complaints ; and for 
ulcerations of the urinary organs; and it is still prescribed in such cases. 
There are few, however, of the present day, who regard the agency it 
exerts to be anything more than the tonic impression made by it on the 
stomach. 

When metrorrhagia or uterine hemorrhage occurs in the unimpreg- 
nated state, great reliance is placed on the use of sedatives, refrige- 
rants and astringents, — the former when the hemorrhage is active, and 
the latter when it is more atonic. Where astringents are indicated, the 
tonic medication is also required, and cases occasionally occur where 
the safety of the patient depends upon the effect exerted, through the 
general system, on the vessels that are pouring out the blood. In a 
former section, the author has referred to an instructive case of this 
kind. When astringents are demanded in metrorrhagia, they can be 
made to come in contact with the affected vessels by means of the 
stomach pump. Cold water — ice cold — is, in this way, a valuable 
agent ; as well as solutions of sulphate of zinc or other saline 
astringents, and infusions or decoctions of vegetable astringents, — 
as of red oak bark, catechu, &c. — which act as styptics. The 
tampon is also an excellent agent after these means have failed, by 
detaining the blood in the vagina, and in contact with the exhaling ves- 
sels, until it has coagulated, and thus acting as a mechanical styptic. 
It is an efficacious remedy in cases of hemorrhage occurring during utero- 
gestation. On the management necessary in these last cases, as well as 
in uterine hemorrhage, occurring during and after delivery, it is unne- 
cessary to dwell, as it consists in manipulations appertaining to the 
science of obstetrics. Astringents are but rarely had recourse to, be- 
cause during utero-gestation, and prior to the delivery of the foetus, 
they cannot be easily thrown up as high as the seat of the hemorrhage ; 
and because other modes of management can be adopted, which strike 
more nearly at the root of the mischief. 

Hemorrhage, when the placenta is not attached over the os uteri, is 
owing to a partial separation of the placenta from the uterus; and the 
only effective mode of rectifying the evil is to cause the uterus to con- 
tract around the foetus, and thus to compress the uterine veins. This 
is done by discharging the liquor amnii. Where the placenta is seated 
over the os uteri, the hemorrhage is unavoidable — not accidental, as in 
the case just described— and there is no safety to the mother or child 
except in speedy delivery. 



108 ASTRINGENTS, 

Again, in hemorrhage after delivery, cold and astringent fluids might 
be thrown into the cavity of the uterus ; but this plan is rarely had re- 
course to. The cause of the hemorrhage is here, also, the want of con- 
traction of the uterus, and the means, found most efficacious, are — if 
the case be urgent — to introduce the hand into the interior of the organ; 
to irritate its inner surface with the fingers, and to press, at the same 
time, on the abdomen. The uterus will generally contract, so as to 
force the hand out of it ; and in ninety-nine cases in the hundred, when 
the organ can be felt in the hypogastric region contracted to the size of 
the fcetal head, the woman may, under ordinary precautions, be deemed 
free from all danger of recurrence. At times, the hemorrhage has re- 
turned under these very circumstances ; but the instances are rare. 
When the case is not so urgent, simple pressure on the abdomen over 
the region of the uterus, continued until it is felt to be contracted, is 
generally sufficient. In most cases of hemorrhage after delivery, the 
flow of blood is so profuse, that there is no opportunity for employing 
any astringent solution or infusion ; but in. the more protracted and less 
alarming varieties, these agents may be employed with much prospect of 
advantage. They can only be regarded, however, as adjuvants. The 
means of primary importance are those obstetrical manoeuvres to which 
allusion has been made. 

The use, then, of astringents in the different forms of hemorrhage 
can be easily understood. In none of the active kinds can they be 
indicated ; and in the passive, great reliance can only be reposed 
on them when they can be made to come into direct contact with the 
vessels that are discharging their blood, whether by rupture or by tran- 
sudation. 

Inflammations of the alimentary canal. — From the general principles 
laid down, it can never happen, that the employment of astringents can 
be looked upon as advisable in any of the more acute varieties of those 
inflammations of the alimentary tube, that are accompanied by dis- 
charges. Accordingly, in inflammation of the lining membrane of the 
small intestines, characterized by pain in the abdomen on pressure, or 
without ; by redness of the tongue and repeated bloody or slimy dis- 
charges ; as well as in the same inflammation, when seated in the large 
intestines, and constituting dysentery, — astringents, during the first and 
active period of the disease, are to be avoided ; but when the complaint 
has persisted for a time, notwithstanding the general antiphlogistic medi- 
cation and regimen, and the constant use of small doses of castor oil to 
remove all offensive secretions from the tube, gentle astringents — as has 
been shown of excitants — may be employed with much prospect of ad- 
vantage. In very urgent cases, it may even be necessary to have 
recourse to the more powerful, administered 'both by the mouth and the 
rectum ; and their agency may be augmented by the addition of opium 
to allay the irritability of the canal, which the state of erethism of the 
mucous membrane so largely developes. Of the vegetable astringents 
employed for this purpose, catechu and kino are the most common :— 
of the mineral, — alum, dilute sulphuric acid, &c. ; and, if these fail, no 
plan can be adopted with better expectation of success than that of 



IN DIARRHOEA. 109 

completely changing the "whole of the physical circumstances, surround- 
ing the individual by travelling exercise, which, at times, removes 
these chronic affections of the mucous membranes, after the best directed 
efforts of the physician have been assiduously, but vainly, exerted. 

The same priuciples apply to the management of diarrhoea^ which is 
caused by a degree of erethism of the mucous membrane, generally 
produced by extraneous substances taken by the mouth, and irritating 
the lining membrane of the intestines. Astringents are here, in the first 
instance, improper. The cause of the mischief must be first removed 
by gentle evacuants, — as oleum ricini, — and it is not unless the dis- 
charges should be frequent, and colliquative, that attempts should be 
made to check them by astringents. At different periods of medical 
history, diarrhoea has been viewed in opposite aspects, — at times, as an 
effort of nature to get rid of morbific matter, and, therefore, not'to be in- 
terfered with ; and, at others, as always injurious, tending to debility 
and death, and consequently to be arrested as speedily as possible. Both 
exclusive views are objectionable. The cause of the mischief must be 
inquired into, and, if possible, removed ; and, let it be borne in mind, 
that an increased number of evacuations may take place in consequence 
of the retention of indurated fecal matter in some portion of the intesti- 
nal tube ; — the irritation excited by its presence inducing augmented 
exhalation from the lining membrane, and stimulating the muscular coat 
by contiguous sympathy, so as to increase the natural peristole of the 
intestines beyond the due bounds. Diarrhoea may be, in this manner, a 
symptom of constipation, and it is not until this state of fecal retention 
has been removed, that a cure can be effected. In the diarrhoea, which 
occurs in phthisis pulmonalis towards its close, and which is occasioned 
by inflammation of the lining membrane of the ileum and colon more 
especially, we can employ only palliatives. The diarrhoea is but a symp- 
tom of the hectic ; and whatever remedies are used, we cannot calcu- 
late on any important advantage from them. It is usual to exhibit an 
opiate, which has the effect of allaying the irritation in some degree ; 
and, occasionally, the Mistura Cretce of the pharmacopoeias is made the 
constituent of the prescription, or the infusion of catechu or kino, or 
some other vegetable astringent ; but, for the reasons mentioned, no cal- 
culation of positive, permanent benefit can be founded on their admin- 
istration. Simplicity in the formation of prescriptions is important, in 
order that we may be able, in all instances, to trace the effects of par- 
ticular remedial agents on particular states of disease. The practitioner 
is often in the habit of combining remedies, taken from different classes 
of medicinal substances, and ' experience' often leads him to ascribe 
virtues to the combination, which are perhaps referable to one ingredient 
of the prescription only. Dr. Thomson gives an instance of this kind. 
Dr. Fordyce thought he had improved the practice in diarrhoea by com- 
bining astringents with diaphoretics, and he recommended a combination 
of ipecacuanha and tormentilla. " We now know that no effect could 
be ascribed to the ipecacuanha in this combination, as an inert tannate 
of emetina is formed ; and, consequently, that the whole of the benefit 
must have resulted from the tormentil, which is indeed an excellent as- 
tringent in this disease." 



HQ ASTRINGENTS, 

B'enriorrhaia— -In that specific inflammation of mucous membranes, 
which constitutes gonorrhoea virulenta, much difference of opinion has 
existed regarding the employment of astringents. When they are used 
at all, it is in the way of injection ; and, whilst they are employed, from 
the first, by some practitioners, they are altogether discarded by others, 
—on the ground, that they are apt to induce stricture or orchitis. The 
author does not think there is much, if any, foundation for these fears. 
When such affections supervene, it is generally owing to the lesions 
produced by the protraction and extension of the inflammation; and the 
practitioner ought not to hesitate to put an end to the specific inflamma- 
tion at once by an astringent or any other plan which is capable of 
accomplishing the object. What has been said of the use of excitants 
and astringents in inflammations of the mucous membranes in general 
applies here ; and the same difficulty exists in knowing whether the 
over distended state of the extreme capillary, or the excited of the vessel 
communicating with it, predominates. When, however, the inflamma- 
tory signs are high ; the extremity of the urethra tumid and painful ; and 
chordee is urgent, the general antiphlogistic treatment had best be con- 
fided in, and astringent injections be postponed until these phenomena 
have ceased. When injections are had recourse to, the metallic astrin- 
gents,— as sulphate of zinc, acetate of zinc, acetate of lead, sulphate of 
copper, sulphate of alumina and potassa, and nitrate of silver, are usually 
selected. 

But whatever hesitancy may exist regarding the use of astringents in 
the early stages of gonorrhoea, none need be entertained when the in- 
flammatory symptoms have almost wholly disappeared, and a state of 
gleet alone remains. Here, not only astringents, but excitants are 
needed ; and the bougie often removes the disease when every kind-of 
injection has failed. This is partly owing to the instrument coming in 
contact with the seat of the discharge, however high up the urethra the 
diseased surface maybe, — which cannot easily be effected by injections; 
— at least, not in the ordinary mode of throwing them up by means of 
a syringe. They may, however, be directed to any part by a cannula,— 
an ordinary silver or elastic-gum catheter for example, — which may be 
passed up until it has nearly reached the seat of the disease, and the 
fluid of the injection be propelled through it. 

Leucorrhcea. — Similar remarks apply to the use of astringent injec- 
tions in leucorrhoea. Little faith can be placed in the administration of 
astringents by the mouth, for reasons applicable to hemorrhages from 
other parts than the alimentary tube, — namely, that the astringent must 
enter the mass of blood, and can, of course, reach the mucous mem- 
brane of the vagina in a state of extreme dilution and admixture only. 
Leucorrhoea — like other inflammations of mucous membranes— is, some- 
times, more inflammatory than at others. It may require the use of 
powerful antiphlogistics in one case; whilst in another the astringent 
treatment may be advisable. At times, it is accompanied by consider- 
able remora of fluids in the membrane, and by much relaxation of parts, 
and it is in these cases chiefly, that mineral astringents, and the astrin- 
gent vegetable infusions and decoctions are employed. Where the 



IN PHTHISIS. Ill 

inflammation and irritation are excessive, soothing topical remedies, — 
as warm milk and water, flax-seed tea, &c, — are rather indicated; or, 
if cold and astringent lotions afford more relief, care must be taken not 
to render the astringency too marked. In such cases, the solutions of 
the metallic salts, used in inflammation of the mucous membrane of the 
urethra, are generally chosen ; but where the atony and relaxation above 
mentioned exist to any great extent, inftisions or decoctions of catechu, 
or of red oak bark, or some other vegetable astringent are generally 
selected. In every case, care must be taken not to make the lotion 
too astringent ; otherwise, as before seen, the inflammation may be 
augmented. 

Diabetes Mellitus. — In this singular disease of the function of nutri- 
tion, characterized by an inordinate discharge of sweet urine, vegetable 
and mineral astringents, in the ignorance that has prevailed of its 
pathology, have been largely prescribed ; but without any benefit. 
The disease does not consist simply of a profuse secretion of urine. 
This is the smallest part of the evil. It is the formation of saccharine 
matter at the expense of the system, which is the main source of mis- 
chief; and this can scarcely be touched by astringents. 

Ephidrosis. — Immoderate sweating is rather an unpleasant symptom 
of certain morbid conditions of the system than a disease itself. One 
or two singular epidemics, of which ephidrosis was a prominent phe- 
nomenon, have occurred from time to time in Europe. The Sudor 
Mnglicus or ' sweating sickness^ was a very severe epidemic disease, 
which appeared in England in 1486 ; and recurred at different times 
until about the middle of the 16th century. It was accompanied by 
' coldness; excessive prostration of strength ; palpitation ; frequency and 
irregularity of pulse ; and generally terminated favourably or unfavour- 
ably in the course of twenty-four hours. The Suette de Picardie is 
another epidemic malady, which has appeared several times in the pro- 
vince of Picardy in France. The principal symptoms were profuse 
sweats, accompanied by a miliary eruption. The disease recurred in 
1821, and has been described at length by M. Rayer, in a work, which 
he did the author the honour to transmit to him. M. Rayer considers 
the Suette miliaire of 1821 to consist of simultaneous inflammation of 
various tissues ; and proposes to class it with variola, rubeola, and 
scarlatina. 

In these two epidemics, the state of the organism appears to have 
been essentially different. Increased exhalation from the cutaneous 
surface may, indeed, take place in two opposite conditions of the vas- 
cular system. In the one, the vital forces may be exalted ; in the other, 
depressed ; and hence the warm, genial perspiration of health, induced 
by exercise or by excitants of any kind ; — and the cold, clammy exuda- 
tion, which accompanies enfeebled powers, and is the precursor of dis- 
solution. 

Phthisis. — In confirmed phthisis, colliquative sweating is one of the 
accompaniments of hectic fever, and cannot of course be removed, 



112 ASTRINGENTS, 

unless the condition of the lungs, which gives rise to the hectic, can be 
rectified. As this is impossible, no signal advantage can be derived 
from the employment of astringents ; although the physician is, at times, 
led to attempt the palliation of an evil — which he cannot remove or 
prevent — in consequence of the complaints of the sufferer. There is 
nothing better adapted for this end, than a combination of tincture of 
Cn opium, and diluted sulphuric acid, — or the acidum sulphuricum aroma- 
ticum. 

Relaxations of parts. — In all relaxations of parts, with which astrin- 
gent solutions can be made to come into immediate contact, they are 
the remedial agents, that are clearly indicated ; hence, they are em- 
ployed in procidentia ani, and procidentia vaginas, with the best 
effects ; — these pathological conditions being usually dependent upon 
a state of atony of the parts concerned. 

Topical diseases. — Lastly, the surgeon has recourse to astringents in 
many of the morbi externi, that fall under his province. Of their use 
in ophthalmia, aphthae, and in erysipelatous and phlegmonous inflam- 
mations, the author has already spoken, as well as of the particular 
morbid states in which their employment seems to be indicated. In 
chronic ulcers of an indolent character, they are used like excitants to 
induce a new action in the ulcerated surface ; and are often beneficial. 
As styptics — chemical as well as mechanical — they are likewise em- 
ployed where the hemorrhage is insufficient to demand the use of the 
ligature ; or where the ligature cannot be easily applied. 

Twenty years ago, a styptic was re-introduced into notice in Italy, 
which astonished the surgical world for a time, but whose operation, 
like that of many agents equally strongly recommended, has been 
found to far exceed its powers. This was the u new hcemastatic" 
as it was termed, Acqua Binelli, so called after Dr. Fidele Binelli, 
the inventor. This liquid is perfectly transparent; almost tasteless; 
having a slightly empyreumatic odour, in which neither salt, earth, 
alkali, nor acid can be perceived by the senses. The first public trials, 
to test its efficacy in arresting hemorrhage, were instituted at Turin, in 
1797, by order of the government ; the results of which were regarded 
favourable. Soon after this Binelli died, and the secret for making the 
preparation is said to have died with him ; but in the years 1829 and 
1830, the successors of Binelli affirmed, that they had found it, and 
fresh experiments were instituted, and repeated in Germany. Various 
blood-vessels were divided on animals, — the femoral and carotid arte- 
ries and the internal jugular veins ; and the cuts were made in every direc- 
tion, some longitudinally ; some obliquely ; others completely across, and 
in all cases the hemorrhage yielded as soon as charpie or lint, steeped 
in Acqua Binelli^ was applied and pressed gently against the wound for 
five or ten minutes. Encouraged by the results of the experiments on 
animals, its effects were tried on man. First. Before the assembled 
class in Berlin, in the operating theatre, after amputation of a finger, 
the arteries of which emitted blood very freely. Secondly. In the case 
of a wound of the hand, caused by a cutting instrument, which entered 



IN TOPICAL DISEASES. 113 

deeply between the metacarpal bones of the thumb and index finger, 
and in which the hemorrhage could not be arrested by compression or 
the tourniquet, without fear of causing gangrene. Thirdly. After the 
removal of an indurated inguinal gland, accompanied by hemorrhage ; 
and, four tidy, after amputation of the thigh on account of a scrofulous 
knee joint, when the blood issued with great force, on the least relaxa- 
tion of the tourniquet, from the crural, perforating, and other muscular 
arteries, as well as from the veins. In all these cases, the hemorrhage 
was speedily and permanently arrested by the application of Acqua 
Binelli without any other aid. It did not cause the least pain on its 
application, nor did it produce any discoloration on the surface of the 
wound, or eschar, or any local or general effect of a disagreeable 
character. 

But the experiments of Dr. John Davy have proved, that the boasted 
Jicqua Binelli is only another example of the numerous remedial agents, 
which have given occasion to inferences not confirmed by farther inves- 
tigations. They completely overthrow the fancied heemastatic powers 
ascribed to the liquid by the German and Italian experimenters. u I 
first examined" — says Dr. Davy, — "into its physical and chemical 
qualities. It proved of the same specific gravity nearly as distilled 
w T ater. It was neither acid, alkaline, nor saline. Its odour was not 
unlike that of coal-gas, not purified, which is lost by boiling. Its taste 
was rather pungent, not in the slightest degree astringent ; in brief, it 
appeared to be merely water, containing a little volatile oil or naphtha, 
and was probably prepared by the distillation of w r ater from petroleum, 
or some kind of tar. I next made trial of it as a styptic. I scratched 
the back of the hand with a lancet till the blood flowed. The water 
applied to the scratch rather increased the bleeding than stopped it. 
The following morning, in shaving, the razor inflicted a slight cut : the 
Jicqua Binelli was again applied, and the result was the same. These 
few and simple trials were made in January 1831, just after I received 
the water; and they of course convinced me that the thing was an im- 
position on the public, and deserving of no further investigation. A 
short time since, my attention was recalled to the subject by a medical 
practitioner of this island, who had studied at Naples, inviting me with 
others to witness the effects of a preparation made in imitation of the 
Jicqua Binelli, and which he maintained was identical with it in com- 
position and virtues. The experiment he invited us to witness appeared 
an unobjectionable one, namely, — the partial division of the carotid 
artery of a goat, the bleeding of which he undertook to stop by means 
of his fluid. He allowed us to expose the vessel and cut it across; 
about one-half of the circumference of the artery was divided, and the 
bleeding was most profuse. He stood ready with compresses moist- 
ened with the fluid, which he instantly applied one over the other, and 
secured them by rolling a bandage about the neck, making moderate 
pressure on the wounded vessel. A little oozing of blood followed 
which soon ceased. He said that in three hours the bandage and 
compresses might be removed, without any renewal of the hemorrhage. 
Accordingly, at the end of three hours they were removed ; but when 
the last compress was raised, the bleeding broke out as furiously as at 

Vol. II.— 8 



114 ASTRINGENTS, 

first and, to save the life of the animal, the artery was secured by liga- 
ture. On examining the last compress, a small coagulum of blood 
was found adhering to it, just the size proper to close the wound in the 
carotid ; thus accounting for the ceasing and renewal of the bleeding. 
Reflecting on this result, and considering the chemical nature of the 
fluid employed to moisten the compresses, which appeared analogous 
to that of Binelli, the conclusion I arrived at was obvious — namely, 
that had the compresses used been moistened merely with common 
water, the effect would have been the same, — the bleeding would have 
been stopped ; and it also appeared very probable, that, had the com- 
presses been allowed to remain undisturbed, there would have been 
no renewal of the bleeding. 

" To ascertain the truth of these inferences, the following experi- 
ments were made. On the same day, February 8th, in the presence of 
several medical officers, I divided partially, transversely, the carotid 
artery of two dogs ; one small and feeble, the other of moderate size 
and strong. In each instance the bleeding was most profuse, till com- 
presses dipped in common water had been applied and secured by a 
bandage, which, as in the case of the goat already given, completely 
stopped the hemorrhage. The small dog, from the proportionally large 
quantity of blood which it lost, was very feeble immediately, and 
appeared to be dying; but it presently rallied, and for several days 
seemed to be doing well. It unexpectedly died on the 15th, seven 
days after the infliction of the wound. The bandage during this time 
had not been touched, and no application had been made. Now, on 
exposing the neck, the wound was found covered with coagulable lymph 
discharging pus; and, on dissecting out the artery and eighth nerve 
contiguous to it, a mass of coagulable lymph appeared lying over the 
wound in the vessel, extending about half an inch above and below it. 
This mass of coagulable lymph having been carefully removed, and 
the artery slit open, the vessel was found quite pervious, not in the 
least contracted. The wound in the fibro-cellular tissue, or external 
coat, was closed by a minute portion of dense coagulable lymph. But 
not so in the middle and inner coats ; in these there was a gaping aper- 
ture, across which, on minute inspection, two fine threads, apparently 
of coagulable lymph, (as if the commencement of the healing process,) 
were observable. The cause of the dog's death was not discovered. 
The other dog did not appear to suffer from the wound. The bandage 
and compresses were removed on the 15th February without the oc- 
currence of any bleeding. On the 20th of the same month, the wound 
in the neck was nearly closed by granulations. The artery was now 
exposed by incision ; and the portion that had been wounded taken out, 
between two ligatures previously applied. On careful examination' of 
this excised part, it was found free from coagulable lymph ; at least 
there was not the same thickening or tumour from lymph deposited, as 
in the former case ; it was probably absorbed. When the external loose 
cellular tissue was dissected away, a very minute elevation, about the 
size of a pin's head, appeared on the site of the wound, the remains of 
the cicatrix externally. The artery was completely pervious, and not 
at all contracted where it had been wounded. Slit open for internal 



IN HiEMASTATICS. 



115 



examination, the wound in the inner coat was marked by a red line in- 
terrupted by two white spots ; there was no gaping ; the edges adhered 
together, excepting at one point; elsewhere the union was complete. 
The white spots resembled the natural lining membrane ; and had the 
whole wound been similarly healed, I believe it would have been impos- 
sible to have traced it. 

" The general results of these experiments, (if I may be allowed to 
speak of so small a number,) are not without interest in application to 
surgery. They show how a hemorrhage from the wound of a large 
artery, which by itself would be speedily fatal, may be easily arrested ' 
by moderate compression through the means merely of several folds of 
linen or cotton moistened with water ; and they further show how, 
under this moderate compression, the wound in the artery heals, the 
vessel remains pervious, and without the formation of an aneurism ; 
and how, after a time, only slight traces of the wound are discoverable. 
Under this moderate pressure the healing of the wounded artery seems 
to be very analogous to that of a wounded vein, and apparently by 
means of the same natural process. Whether similar results could be 
obtained, were trial made of the same means in the wounds of arteries 
in the human subject, can only be ascertained positively by judicious 
experiments. The probability is, that the results would be the same. 
The analogy is very complete, and some facts well known in surgery 
accord with it, not to mention the experience of the effects of the Acqua 
Binelli, as certified by men of high respectability. 

" It was my intention to have given a selection of the certified cases 
in favour of the Aequo, Binelli, brought forward in the pamphlet which 
is furnished with the water. But on reconsidering them, it appeared a 
superfluous labour, as the results, (giving them credit for correctness,) 
however excellent in a curative point of view, are no more than the en- 
lightened surgeon of the present time may readily admit to be owing to 
water dressings alone, without the aid of pressure, — the majority of in- 
stances adduced being examples of gun-shot wounds and contused 
wounds, from which there was no profuse bleeding, and no necessity, 
according to the ordinary mode of surgical treatment, for securing 
wounded vessels. I have laid stress on the effect of the pressure 
afforded by the wet compresses applied in the experiments related, be- 
lieving that the virtue of the means consists in the pressure, — of course 
not in the water, excepting so far as it renders the compresses better 
fitted for adaptation to the wound to produce the degree of resistance 
requisite to counteract the heart's impulse in the vessel ; and also better 
fitted to exclude atmospheric air. I would also lay stress on the mode- 
rate degree of pressure that is produced in the manner described, — 
allowing the blood to pass through the canal of the artery, and, as be- 
fore observed, doing little more than resisting the momentum of the 
blood in its passage from the moving source. The importance of this 
moderate degree of pressure, which has the effect of reducing as much 
as possible the wounded artery to the condition of a'wounded vein, is, 
ifldonot deceive myself, very considerable. When I have pressed 
with the fingers forcibly on the compresses applied to the wound, ex- 



116 ASTRINGENTS. 

pecting at the moment to arrest the bleeding, I have been disappointed. 
The hemorrhage has continued ; and it only ceased when the com- 
presses have been secured, and not tightly, by a roller passed around 
the neck of the animal. And, further, in illustration, I may remark, 
that I have been equally disappointed in using graduated compresses, 
insuring considerable pressure on the wound. This means has failed, 
when general moderate pressure, effected by compresses about two 
inches long and one wide, succeeded. On considering the comparative 
circumstances of these two modes of applying compression, therefore, 
the difference of result is perhaps what might be expected. The severe 
pressure can hardly arrest the bleeding except by pressing the sides of 
the vessel together and closing the canal, the accomplishment of which 
requires a most nice adaptation, and a force which cannot easily be ap- 
plied with steadiness except by mechanical means, and in situations 
affording firm support beneath. Should the expectation which I have 
ventured to form of this method of stopping the bleeding of wounded 
arteries of a large size in man be realized on trial, I need not point out 
how very useful it may prove in military surgery, — how very available 
it will be in the field and in battle, especially in great actions, when, 
however numerous and well-appointed the medical staff of an aimy, the 
•number of wounds requiring attention must always exceed the means of 
affording adequate surgical relief, according to the plan of treating them 
at present in use, of suppressing hemorrhage by ligature. I have said 
nothing of the boasted efficacy of the Acqua Binelli given internally. I 
trust it is as little necessary to make any comments on it now-a-days, 
as on the tar-water of Bishop Berkeley, so very analogous in nature and 
reputation. Both the one and the other in some cases may be service- 
able ; but their principal recommendation appears to be, that in doubt- 
ful cases they are innocent." 

Dr. Davy's observations have been given at some length, because 
they contain interesting information, as regards the physiology, patho- 
logy and therapeutics of wounded vessels, and convey a useful lesson 
to the inquirer, — not to deduce inferences from inadequate data, with- 
out having investigated every collateral circumstance that may bear 
upon the question. Were this course pursued, we should not have so 
many examples, of the experientia falsa as we are daily doomed to wit- 
ness. It has been suggested that Acqua Binelli may be indebted for its 
fancied haBraastatic property to creasote in some form ; but Dr. Davy's 
explanation appears all sufficient to account for the phenomena. (For 
other testimony, in regard to the Acqua Binelli, see the author's New 
Remedies, 5th edit., p. 68, Philad. 1846.) 

To the same work the author may refer for information in regard to 
the Acqua Brocchieri and other hseraastatic waters, on which much 
was said in this country and elsewhere, a few years ago, but to which 
the unbiassed observer is compelled to consider the remarks made on 
the Acqua Binelli to be equally applicable. Neither the Acqua Brocc- 
hieri, nor the Eau "hemastatique de Tisserand ; — nor — as will be seen 
hereafter — the Ergotin or Extrait hemastatique de Bonjean, is possessed 
of the hsemastatic virtues that have been assigned to them. 



SPECIAL ASTRINGENTS. 117 

Such is a general view of the modus operandi of astringents in the 
principal diseased conditions of the frame. When properly employed, 
they are by no means the least useful of our medicinal agents. 



SPECIAL ASTRINGENTS. 

I. Vegetable Astringents. 

1. AC'IDUM TAN'NICUM.— TANNIC ACID, TANNIN. 

Tannic acid or tannin — as before remarked — is the great active prin- 
ciple of vegetable astringents. It became desirable, consequently, to 
separate it, in order that it might be administered in a state of purity. 
Different processes have been recommended for this purpose, but that 
of M. Pelouze appears to have superseded others, and has been adopted 
in the last edition of the Pharmacopoeia of the United States, (1842.) 
It consists in extracting it from galls by ether , by the process of dis- 
placement. 

When thus prepared, tannic acid is of a yellowish white colour ; of a 
strongly astringent taste ; and is soluble in water, alcohol and ether, 
reddening litmus paper, and forming salts with bases. 

Tannic acid is a very powerful astringent, and may be employed in 
all cases in which astringents are considered- necessary. One advan- 
tage is the minuteness of the dose in which it can be given. It has 
been much employed by the Italian physicians especially, both in ex- 
ternal and internal hemorrhages. When applied to the mucous mem- 
branes, it appeared to Cavarra to cause such a condensation and con- 
traction of tissue, that the glands or follicles could no longer afford 
passage for the mucus which they secreted. It has been used in 
discharges from mucous membranes ; and in the colliquative sweats of 
hectic fever. 

^ The dose is from a quarter of a grain to two or three^jfrains, generally 
given in the form of pill. It may, also, be used as an enema in chronic 
diarrhoea and dysentery, or in prolapsus ani ; and has been injected into 
the urethra by M. Ricord, in cases of blennorrhcea virulenta, in the 
quantity of 9ij of tannic acid to §viij of aromatic wine of" the French 
Codex, or of red wine ; and in a less proportion in cases of chronic 
blennorrhcea or gleet. In blennorrhcea of the female, he doubles the 
quantity of tannic acid; and even carries it still farther. 

Mr. Druitt is of opinion, that in any case in which a vegetable astrin- 
gent is indicated, tannic acid should have the preference. A simple 
solution of it in distilled water, he says, is much more easily and quickly 
prepared, as well as much more elegant, than the ordinary decoctions 
or infusions of oak bark, catechu, &c. Moreover, it may be prepared 
of uniform strength, and free from foreign inert matter ; and is not liable 
to decompose quickly. It has, in fact, he considers, all the advantages 



118 SPECIAL ASTRINGENTS. 

which the other simple vegetable principles have over crude prepara- 
tions from the herbs or extracts in which they are contained. In sore 
nipples, Mr. Druitt has found it invaluable. He employs it in solution 
— five grains to the fluidounce of distilled water — on lint covered with 
C^ oiled silk. He has also found it of great service in toothache. The 
gum around the tooth is first scarified with a fine lancet, and then a 
little cotton wool, embued with a solution, of a scruple of tannic acid, 
and five grains of mastich in two drachms of ether, must be put into the 
cavity, " and if the ache is to be cured at all, this plan will put an end 
to it in nine cases out often." 

2. AC'IDUM GAL'LICUM.— GALLIC ACID. 

• 

This acid is by no means so abundant as the tannic, and appears to 
be produced by an alteration of the latter. A solution of tannic acid 
in water exposed to the air gradually absorbs oxygen, and deposits 
crystals of gallic acid, formed by the destruction of tannic acid. To 
prepare gallic acid, a strong extract of gallnuts in cold water may be 
precipitated in the cold by sulphuric acid ; the thick mass be mixed 
with dilute sulphuric acid, be expressed whilst still humid, and intro- 
duced in this state into a mixture of sulphuric acid with two parts of 
water at the boiling temperature. The liquid is boiled for some 
minutes, and then allowed to cool : crystals of gallic acid are deposited, 
which may be purified by crystallizing again from water, converting the 
new product — which is still coloured — by means of acetate of lead, into 
an insoluble gallate of lead, which is washed, then diffused through 
water, and decomposed by a stream of sulphuretted hydrogen gas : the 
sulphuret of lead, thus formed, assists in carrying down the colouring 
matter. 

Gallic acid is in thin, silky needles; requires 100 parts of cold water 
to dissolve it, and three of boiling water. It is very soluble in alcohol, 
and, to a slight extent in ether. The solution in water has an acid and 
astringent taste, and is gradually decomposed by keeping. 

It has been recently much extolled as a valuable astringent. It has 
already been remarked (p. 107) that the successful operation of Ruspini's 
styptic in hsematuria has been ascribed to it. In some cases of menor- 
rhagia, this acid has been employed by Professor Simpson, and by Dr. 
Stevenson of Edinburgh, with the most successful results. The former 
gave it during the intervals, as well as during the discharge, in doses of 
from 10 to 20 grains in the day, made into pills ; and it appeared to him 
. to have the advantage over most other anti-hemorrhagic medicines, that 
^y^ it had no constipating action. He was first induced to prescribe it from 
finding a case of very obstinate menorrhagia get well under the use of 
Ruspini's styptic. Professor Simpson suggests, whether the anti-hemor- 
rhagic properties of some others of the astringent drugs may not be 
dependent upon the gallic acid as much as, or even more than, upon the 
tannic acid which they contain, — or upon the tannic acid becoming 
changed into gallic acid within the body. Its value in uterine hemor- 



CATECHU. 



119 



rhage and hematuria has been confirmed by others, and Messrs. Ballard 
and Garrod declare it to be one of the most powerful astringents that 
the art of chemistry has derived from the vegetable kingdom ; and that 
a tolerably extensive experience enables them to declare it to be an in- 
valuable remedy in most forms of passive hemorrhages and fluxes. 
They affirm, however, that if its use be prolonged beyond two or three 
days, it manifests some constipating tendency. This is opposed to the 
observation of Professor Simpson ; but is probably accurate. They af- 
firm, moreover, that the excessive sweats and expectoration of phthisis; 
and the copious expectoration of chronic bronchitis are much influenced 
by it; which is less probable, as these phenomena are dependent upon 
pathological conditions of which they can only be regarded as expres- 
sions. They found the acid highly useful as an injection in leucorrhoea. 
The ordinary dose of gallic acid is from two grains to five or more 
in the form of pill. An injection may consist of from a scruple to a 
drachm to the pint of water. 



3. CAT'ECHU. 

Catechu is an extract prepared from the wood of Acacia catechu, 
Mimosa catechu ; Sex. 

Syst. Polygamia Monce- Fig. 144. 

cia ; Nat. Ord. Legumi- 
hosae, which is indigenous 
in various parts of the East 
Indies, and is now common 
in Jamaica. (Pereira.) 
The Edinburgh College 
considers it to be not only 
the extract of the wood of 
Acacia catechu ; but of the 
kernels of Areca catechu, 
Betel nut tree, Catechu 
palm ; Sex. Syst. Monce- 
cia Hexandria ; Nat. Ord. 
Palmae ; which inhabits 
most of the Indian conti- 
nent and islands ; and of 
the leaves of Uncaria 
gambir or Nauclea gam- 
bir ; Sex. Syst. Pentandria Monogynia ; Nat. Ord. Rubiacese, — 
Cinchonacese, (Lindley,) which is a native of Malacca, Sumatra, Prince 
of Wales Island, Cochinchina, and other parts of Eastern Asia. It 
would appear, however, that the extract obtained from the two last 
sources is rarely, or never, seen in European or American commerce. 
Catechu is supposed, also, to be obtained from Butea frondosa or Dhak 
tree, of the East Indies ; Sex. Syst. Diadelphia Decandria ; Nat. Ord. 
Leguminosae. 

The number of catechus described by pharmacologists is considerable. 
At least as many as thirteen varieties have been admitted ; but, although 




' Acacia catechu. 
1. Stamens. 2. Legume. 



120 SPECIAL ASTRINGENTS. 

these may be of commercial and pharmaceutical interest, they are of 
less moment to the therapeutist. They are described at length by some 
of the best modern pharmacologists. In this country, we are not troubled 
with varieties. 

The drug is procured either directly from Calcutta or from London. 

Catechu, formerly termed Terra Japonica — as met with in the shops 
— is in masses of different shapes and sizes ; of a rusty brown colour 
externally, and internally of a colour varying from a pale reddish to a 
dark liver. It is devoid of smell, and has an astringent bitter taste. 
That which is preferred in this market is of a dark colour, and easily 
broken into small angular fragments, with a smooth, glossy surface, 
. bearing some resemblance to kino. (Wood & Bache.) It is often mixed 
with various impurities ; and, with the exception of these, is soluble in 
water. Small, successive portions of cold water remove chiefly the astrin- 
gent part ; and a much larger proportion of water is required to dissolve 
the remainder, which is principally an extractive resinoid matter with 
acid properties. (Christison.) Hot water dissolves both principles ; 
but if the infusion be made very strong, a reddish extractive matter is 
deposited on cooling. Alcohol and diluted alcohol dissolve it more 
readily than water. When subjected to analysis, it is found to consist 
of about 50 per cent, of tannic acid, peculiar extractive mucilage, and 
insoluble matter. 

This is one of the most powerful of the vegetable astringents ; and 
is as well adapted for cases in which such agents are demanded as any 
article belonging to the class. In atonic conditions of the mucous 
membrane of the mouth and fauces ; in the chronic forms of diarrhoea 
and dysentery ; in asthenic hemorrhages ; and in chronic mucous dis- 
/ charges from the genito-urinary organs, it has been prescribed with much 
success. It has also been used as a wash, in the form of infusion ; and 
in that of ointment to atonic ulcers, in which an astringent is indicated. 
A small piece of it, held in the mouth, and allowed to dissolve in the 
saliva, has been beneficial in relaxation of the uvula; and it has been 
added to other substances, as to powdered cinchona, to form a dentrifice 
for spongy gums. 

The dose in powder is from gr. x to £j, which may be given in bolus, 
or rubbed up with sugar, gum arabic and water. 

INFU'SUM CATECHU COMPOS'ITUM, COMPOUND INFUSION OF CATECHU. {Cate- 
chu pulv. §ss ; Cinnam. cont. 3j 5 Aqua bullient. Oj.) Cinnamon adds 
aromatic virtues to catechu ; and the infusion is much used in chronic 
discharges from the mucous membranes, especially of the alimentary 
canal, — at times alone ; at others, associated with opium. It ought not 
to be given along with preparations of iron. The dose is f.5j to f.5iij> 
repeated according to circumstances. 

TINCTU'M CATECHU, TINCTURE OF CAT'ECHU. {Catechu giij; Cinnam. 
cont. ^ij ; Alcohol, dilut. Oij.) The same remarks apply to the com- 
position of this tincture as to that of the infusion. It is rarely given 
alone, the alcohol being so often an objection ; but is often added to 



KINO. 121 

chalk mixture, and occasionally to the infusion of catechu. Its dose is 
from f-5j to f.jiij, in sugared water, or in Port wine and water. 

4. KINO. 

Tn the Pharmacopoeia of the United States, kino is said to be an ex- 
tract obtained from an uncertain plant ; whilst in the London Pharma- 
copoeia it is assigned to Pterocarpus erinaceus, Hedgehog Pterocarpus : 
Sex. Syst. Diadelphia Decandria ; Nat. Ord. Leguminosse, a tree 
which inhabits the woods on the Gambia and Senegal. The Edinburgh 
College assigns it to the same, and to other undetermined genera and 
species. 

Different varieties are described in pharmacological works. Accord- 
ing to Dr. Pereira, two substances are met with in English commerce 

Fig. 145. * 




Pterocarpus marsupium. 

under the name, — the one called Botany Bay kino, which is the in- 
spissated juice of Eucalyptus resinifera ; the other, apparently an extract 
imported from Bombay and Tellicherry, and which he terms East India 
kino. The latter is presumed to be the substance referred to in the 
Pharmacopoeias, as it is always regarded in commerce as genuine gum 
kino. Ten years ago, (1839) it was affirmed by Dr. Gibson of the 
Bombay service, that this kino is the produce of Pterocarpus marsupium ; 
and the subsequent observations of Drs. Royle, Pereira and Wright, 
according to Dr. Christison, have established the fact, that all the kino 
of British commerce is prepared at Anjarakandy, near Tellicherry in 
Malabar, from that tree, which is one of the most magnificent in the 
forests of India. When longitudinal incisions are made into it, a great 
quantity of red juice exudes, which, on being simply dried in the sun, 
cracks into little irregular angular masses constituting the kino of the 
shops. 



122 SPECIAL ASTRINGENTS. 

As met with in the shops, kino is in small, angular, shining fragments ; 
of a dark brown or reddish brown colour, affording a powder which is 
of a lighter hue. It is brittle, but softens in the mouth ; and colours 
the saliva red. It is devoid of smell, and has a very astringent taste. 
Cold water. dissolves a portion of it, and hot water a larger quantity ; 
whilst alcohol dissolves the greater part. When subjected to analysis, 
it is found to consist of tannic acid, and peculiar extractive, 75 per 
cent. ; red gum ; and insoluble matter. 

Kino is closely allied, both in its chemical and medical virtues, to 
catechu, with which it has, indeed, been considered by some to be 
identical. It is given in the same affections. 

The dose of the powder is from ten to thirty grains. An infusion 
made by pouring eight fluid ounces of boiling water on two drachms 
of kino, may be given under the same circumstances as lnfusum catechu 
compositum. The dose of this may be f.^j to f§iij. A tincture 
(Ki?io, pulv. ^iiiss ; Alcohol. Oij. imperial measure) is officinal in the 
London Pharmacopoeia. It becomes gelatinous, however, when kept; 
unless when prepared by displacement. It is used under the same cir- 
cumstances, and in the same doses as Tinctura catechu. 

5. GALLA.— GALLS. 

Galls are morbid excrescences on Quercus bifectoria ; Sex. Syst. 
Monoecia Polyandria ; Nat. Ord. Cupuliferae ; which abounds through- 
out Asia Minor, and especially along the coasts of the Mediterranean. 
The young twigs of the plant are liable to be'punctured by an insect 
of the Gallicolx or Diploleparix tribe, called Cynips gallce tinctorice, C. 
quercusfolii, or Diplolepis gallce tinctorice, which deposits its eggs, and 
gives rise to so much irritation, that the nutrition of the part becomes 
modified, and a tumour or excrescence is formed which is termed a 
gall. In the interior of this, the young insect finds food during its 
transformation ; and ultimately attains the state of fly, when it penetrates 
the gall and escapes. This usually occurs about the end of July; but, 
as the galls are of finest quality just before the escape of the insect, they 
are generally gathered about the middle of July. Those that are ex- 
ported from Aleppo — hence called Aleppo galls — are the best. Those 
from Smyrna contain a larger admixture of white galls ; and are, there- 
fore, less prized. Others, brought from India, termed East India galls, 
closely resemble those from the Mediterranean. They are said to grow 
in Persia, and to be taken thence by the Arab merchants to Calcutta. 
(Ainslie). Large quantities of these were introduced into the United 
States some years ago. The galls of Asia Minor and Syria are chiefly 
brought to this country from the ports of Smyrna and Trieste. (Wood 
& Bache.) In English commerce, three kinds of galls are distinguished 
— the black or blue, the green, and the white ; no essential difference, 
however, exists between the first two. They are the best, and are 
gathered before the insect has issued; whilst the white galls are col- 
lected for the most part after the insect has escaped, and hence they are 
found to be perforated with a circular hole. They are all devoid of 



KRAMERIA. 123 

odour ; and have a styptic and powerfully astringent taste. The white 
kind, however, possesses these qualities in an inferior degree. 

They yield their astringent properties to water, alcohol and ether. 
Water seems to be the best menstruum ; and, next to it, dilute alcohol. 
When analyzed by Sir Humphry Davy they were found to consist of 
26 per cent, of tannic acid ; 63 of lignin ; 6.2 of gallic acid ; 2.4 of 
gum, united with insoluble tannin ; and 2.4 of saline matters. It has 
been found, however, that the tannic acid is contained in larger quan- 
tity than was estimated by Sir Humphry, — more recent and exact 
processes showing, that it amounts to 40 or even 60 per cent. 
(Christison.) 

Galls are an excellent and powerful astringrnt, possessing at least as 
much tannic acid as catechu ; but they are not by any means so often 
prescribed internally. They may be used, however, in the same affec- 
tions. An infusion prepared of ^iv of the galls to fjvj or f.Iviij of 
boiling water may be given internally in the dose of f.iss to f.iij ; but 
it is more frequently used as an astringent wash, and is occasionally pre- 
scribed as an injection in chronic diarrhoea and dysentery, and in leu- 
corrhcea, — or wherever a topical astringent is needed. The dose of 
the powder, which is rarely prescribed, is from ten to twenty grains. 

TINCTU'RA GAIM, TINCTURE OF GALLS. (Gall. cont. §iv ; Alcohol, dilut. 
Oij. Prepared either by maceration or by displacement.) This is a 
powerfully astringent preparation ; and when diluted with water, makes 
a good wash or gargle. It is rarely given internally ; its chief use, in- 
deed, is as a chemical test. 

IJNGUEN'TUM GALLjE, OINTMENT OF GALLS. {Gall pulv. gj ; Adipis gvij.) 
This has been a favourite application with many practitioners in 
hemorrhoids, after the inflammatory stage has passed away. Some 
have employed it in the same cases much stronger, — the ointment being 
formed of equal parts of powdered galls and lard or butter. The Lon- 
don and Edinburgh Colleges have an Unguentum GALLiE Compositum, 
formed of Galls, in very fine powder, Jij ; Opium powdered, 3j ; Lard, 
Ij. The author has often used this ointment in hemorrhoidal affections 
with marked advantage. 

6. KRAME'RIA.— RHAT'ANY. 

The root of Krameria Triandra, Rhatany ; Sex. Syst. Tetrandria 
Monogynia ; Nat. Ord. Polygalese,— Krameriaceae, (Lindley,) is offici- 
nal in all the Pharmacopoeias of Great Britain and in that of the United 
States. The plant inhabits the mountainous parts of Peru, especially in 
the district of Huanuco and other localities in which cinchona flourishes. 
According to Tschudi, most of the Rhatany which is exported to Eu- 
rope is obtained in the southern provinces of Peru, particularly in 
Arica and Islay. 

As met with in the shops, it consists of a short root-stock, from half 



124 



SPECIAL ASTRINGENTS. 




an inch to two inches in diameter ; and of numerous roots proper, which 
_. ,.- are simple or branched, 

Fig. 146. , " » , « , .,' 

one or two feet in length, 
and varying in thickness 
from that of a writing quill 
to that of the thumb. The 
bark is of a dark brownish- 
red colour, w 7 rinkled and 
warty on the root-stock, 
but smoother on the bran- 
ches. The central woody 
portion is of a yellowish or 
pale red colour. As the 
bark contains the largest 
amount of astringent mat- 
ter, the smaller branches 
are preferred. It is devoid 
of smell, and of a very bit- 
ter astringent taste. The 
virtues of the root are 
readily yielded to water 
and to alcohol. 

When subjected to ana- 
lysis, it has been found to 
contain about 40 per cent, 
of tannic acid ; and, according to M. Peschier, a peculiar acid, called by 
him kramerin ; the properties of which are but little known ; and to 
which, as well as to the tannic acid, the astringency has been ascribed. 
Rhatany is an excellent astringent, well adapted for all cases in which 
that class of remedies is needed. In chronic diarrhoea and dysentery, 
it is frequently administered, both by the mouth and rectum. It is 
^/v> sometimes used as a tooth-powder, mixed with equal parts of orris root 
and charcoal ; and a tincture is not unfrequently made by the dentists 
as an astringent tooth-wash in looseness of the gums. 

The dose of the powdered root is from gr. x to 3ss ; but it is not 
so often prescribed as the infusion or extract. 

A tincture may be formed by digesting three ounces of the bruised 
root in a pint of proof spirit ; and a compound tincture is formed by 
adding to this one or two ounces of cinnamon, or half an ounce of 
Virginia snakeroot. Both these are astringent stomachics. A syrup 
of rhatany is sometimes prepared by making a saturated cold infusion, 
and adding sufficient sugar. A tea-spoonful of this is a dose in the 
chronic profluvia of children. 

INFU'SUM KRAMEM, INFUSION OF RHAT'ANY. (Krameriae contus. §j ; 
J&qua bullient. Oj.) The dose of this is f.^j. to f.iij. 

TINCTITRA RRAME'RUE, TINCTURE OF RHAT'ANY. {Kramer, pulv. §vj; Al- 
cohol. dilut.O'i) ; made by maceration or by displacement.) This tinc- 



Krameria triandra. 



QUERCUS TINCTORIA. 



125 



ture may be added to astringent infusions or mixtures, or may be taken 
alone mixed with water. Dose f.^j to f-5iij- 

EXTRAC'TUM KRAME'RLE, EXTRACT OF RIIAT'ANY. This is prepared by 
evaporating an infusion made by displacement. It is also occasionally 
imported, ready made, from South America. The .dose is gr. x to 9j. 

SYRUTIIS KRAMERS, SYRUP OF RHAT'ANY. {Extract, kramer. |ij ; Sac- 
char, ggiiss ; Jiqua Oj.) This is a pleasant astringent syrup in the 
diseases of childhood, in which it may be given in the dose of a tea- 
spoonful. It may also be added to astringent mixtures. 



7. QUERCUS ALBA.— WHITE OAK BARK ; and 

8. QUERCUS TINCTO'RIA.— BLACK OAK BARK. 

Of the numerous oaks, — Sex. Syst. Moncecia Polyandria ; Nat. Ord. 

Cupuliferae, (Lindley,) — that flourish in our forests, these two are alone 

officinal : and the • 

s • 'A Fig. 147. 

former is conceived B 

to resemble most 

Quercus peduncula- 

ta, Common British 

Oak. 

White Oak is met 
with in every part 
of the United States, 
but is more com- 
mon in the Middle 
states. Its bark is 
of a whitish colour, 
which distinguishes 
it from the other 
species. As we 
meet with it de- 
prived of its epi- 
dermis, it is of a 
light brown colour, 
of a coarse texture, 
and not readily re- 
duced to powder. 
Its taste is astrin- 
gent and bitterish. Yo°ungfIuiu 
It imparts its pro- 
perties to water and to alcohol, 
tannic and gallic acids. 

Black Oak has a furrowed bark of a dark colour, which is more 
bitter than the bark of the white oak: it is distinguished by its staining 
the saliva yellow, and is used, under the name of Quercitron, to dye 
silken and woollen fabrics yellow. It contains a considerable amount 
of tannic acid. 




Quercus pedunculata. 

Male eatkins. b. Stamens, c. Female involucre and stigmas, d. 
The same magnified. /. A cotyledon with the radicle. 



These are mainly dependent upon 



126 



SPECIAL ASTRINGENTS. 



Oak bark is a powerful astringent, and is adapted for all cases in 
which astringents are needed ; yet it is rarely given internally. In de- 
coction, it is often employed externally, both by the profession and the 
laity, in relaxation of parts — as in elongation of the uvula, relaxed sore 
throat, prolapsus ani, &c, and in chronic discharges from the bowels 
and vagina. It is said to have been used with advantage in certain 
diseases of childhood, — as a bath, for example, in marasmus, scrofula, 
cholera infantum, &c, where the stomach would not receive tonic and 
astringent remedies kindly; but it is not easy to see how any consider- 
able benefit could be derived from it. It has even been affirmed to 
cure intermittents in children, when administered in this manner. It 
has also been used beneficially, as a wash, in flabby ill-conditioned 
ulcers. Like alum, finely powdered bark has been inhaled in cases of 
phthisis pulmonalis, and especially in laryngeal phthisis. The dose of 
the powder is from 3ss to 3j ; but it is scarcely ever given in this form. 
The bark of the white oak is always preferred as an internal remedy, 
in consequence of that of the black oak seeming to irritate the bowels. 

DECOC'TUI jiUERCUS ALM, DECOCTION OF WHITE OAR BARK. (Querc. 
alb. contus. 5 j ; Jiquce, Oiss ; boiled to a pint.) The dose of this is 
f.?ij to f-5iv; but it is rarely used except as an injection or lotion. 



9. H.EMATOX'YLON —LOGWOOD. 

Logwood, Cam-peachy Wood, is the w T ood of Hasmatoxylon Campe- 
chiajium ; Sex. Syst. Decandria Monogynia; Nat. Ord. Leguminosae; 
a tree, which is indigenous in Central America ; and grows wild in 
Jamaica and other West India islands. 

Logwood, as an article employed by dyers, is well known in com- 
merce. It is imported in billets, the bark and white sap-wood being 

chipped off", and the inner 



Fig. 143. 




Haemaioxylon campechianum. 
1. Style. 2. Legume. 



wood or duramen sent 
abroad. This is of a deep 
red colour, but it becomes 
dark by exposure to the 
air, and or a blackish 
brown colour. In the 
shops, it is kept in chips, 
or rasped into coarse pow- 
der. It has a peculiar, 
rather agreeable smell ; 
and a sweetish, astringent, 
and subsequently bitterish 
taste. When chewed, it 
colours the saliva violet. 
The colouring matter is 
extracted by both water 
and alcohol, so as to form 
deep purple solutions. 
When subjected to analy- 
sis, it has been found to 



uva imsi. 



127 



C 



contain volatile oil; a red crystalline substance of a slightly bitter, acrid 
and astringent taste, called hasmatin or hematoxylin ; a fatty or resinous 
matter; a brown substance containing tannin; glutinous matter; acetic 
acid ; woody fibre, and various salts. 

It is a gentle astringent and tonic ; and is prescribed occasionally in 
chronic diarrhoea and dysentery, and other profluvia in which a mild 
astringent is indicated. It is often given in cholera infantum after the 
active stage has passed away. It is always administered in one or 
other of the following officinal preparations. 

DECOC'TUM HMATOXTLI, DECOCTION OF LOGWOOD. {Hsematoxyl. §j ; 
Aquce Oij— boiled to a pint.) The London and Dublin Colleges add a 
drachm of Pulv. Cinnamom. towards the end of the boiling. The dose 
of this is f.3j. to f.^ij to adults ; and f.3ij to f.|ss to children. 

EXTRAC'TUM HMATOXTLI, EXTRACT OF LOGWOOD. (The decoction evapo- 
rated.) This extract appears to possess all the virtues of the wood. It 
is given in the dose of gr. x to 3ss in solution. When made into pills, 
and kept for any length of time, it becomes so hard as to pass, at times, 
through the bowels undissolved. 

10. TORMENTIL'LA.— TOR'MENTIL. 

Tormentil is the root of Potentilla Tormentilla, Tormentilla erecfa, 
Common tormentil or Septfoil ; Sex. Syst. Icosandria Polygynia ; Nat. 
Ord. Rosacea ; — a small perennial plant common throughout Europe. 

The root — which is officinal in the secondary list of the Pharmacopoeia 
of the United States — as met with in the shops, is of very irregular 
shape ; generally of about the thickness of the first joint of the fore- 
finger. Its colour is deep brownish-red externally, and flesh-red 
within. It has a slightly aromatic odour, and a very astringent taste ; 
and yields its virtues to water and to alcohol. When subjected to 
analysis, it has been found to contain a trace of volatile oil ; 17.4 per 
cent, of tannin; 20 of colouring matter; about 28 of gum; and 7.70 
of extractive. 

Tormentil is a powerful astringent, — one of the most so of the class; 
yet it is not much used, although applicable to all cases in which as- 
tringents are needed. Its dose, in powder, is from 3ss to Jj ; but it is ^ 
more frequently prescribed in decoction, {Tormentil. ^ij ; Aquce, Oiss. 
Boil to a pint. Dose, f.^j to f.^ij, repeated three or four times a day.) 

11. UVA URSI. 

The general and medical properties of uva ursi are described under 
Antilithics, (Vol. i., p. 304,) and it is there stated, that all its medi- 
cinal agency is probably as a tonic and astringent. It is unquestionably 
a good astringent, and is adapted for all the cases in which the other 
vegetable astringents appear to be required ; but does not seem to pos- 






128 



SPECIAL ASTRINGENTS. 



sess any peculiar properties, or superior efficacy. It is in chronic cys- 
tirrhoea that it has been most celebrated ; and its use has been sug- 
gested in chronic bronchitis. The dose of the powder is from 9j to 
5j ; but it is more generally given in the form of the 



DECOC'TCM UVE URSI, (Vol. i. p. 305.) 
to f.iij three or four times a day. 



The dose of this is from f.^j 



12. GERA'NITJM.— CRANESBILL. 

This is the root of Geranium maculatum ; Sex. Syst. Monadelphia 

Decandria ; Nat. Ord. Gera- 



Fig. 149. 



niaceae ; a plant, which is 
indigenous throughout the 
United States, flowering from 
May to July. The root is 
officinal, and is collected in 
autumn. This, when dried, 
is in pieces from one to three 
inches in length, and from a 
quarter to half an inch in 
thickness ; somewhat flat- 
tened, twisted, wrinkled, 
tuberculated, and beset with 
slender fibres ; of an amber 
brown colour externally ; in- 
ternally of a reddish gray. 
It is a pure astringent ; its 
active constituent being tan- 
nic acid. It yields its virtues 
to water and to alcohol. 

Geranium is used in the 
same cases as other astrin- 
gents ; and, owing to its be- 
ing devoid of bitterness, or 
other disagreeable flavour, it 
is adapted for infants, or for 
adults whose stomachs are 
delicate. It is sometimes 
used as an astringent injec- 
tion in chronic diarrhoea and 
dysentery, leucorrhoea, &c, 
and as a wash in mercurial 
ptyalism, and to indolent 
ulcers. The dose of the 
powder is gr. xx to 5ss ; but 
It is most commonly prescribed in decoction, (Geran. 

It is occasionally 




Geranium maculatum. 



it is rarely given 

X] ; Jiquce Oiss ; coque ad Oj. Dose, f.^j to f.^ij) 

given boiled in milk to children. 



ROSA GALLICA. 129 

13. GRANA'TI FRUCTUS CORTEX.— POME'GR AN ATE RIND. 

This is the rind of the fruit of Punica granatum, already referred to. 
(Vol. i. 219.) It is met with in the shops, in irregular, arched, dry, brittle 
pieces, which are devoid of odour, very astringent and slightly bitter ; 
of a brown colour externally, and yellow within. It contains about 19 
per cent, of tannic acid. 

Pomegranate rind has been used as an astringent, chiefly in the form 
of decoction, — (Granat. fruct'. cort. §ij ; Aquae destillat. Oiss ; boil to a 
pint. Dose, f.3j ;)— in chronic diarrhoea and dysentery ; and in the 
colliquative sweats of hectic fever. It has, likewise, been prescribed as 
an astringent injection in leucorrhcea ; as a gargle in relaxed sore throat, 
and as a wash in loose flabby ulcers, — in the very cases in which as- 
tringents in general are indicated, — but it is not much used on this side 
the Atlantic. The powdered rind has been given in the dose of gr. 
xx. to 3ss and more. 

14. ROSA GAL'LICA.— RED ROSES. 

The petals of Rosa Gallica, — red, French or Provins rose, Sex. Syst. 
Icosandria Polygynia ; Nat. Ord. Rosaceae— a native of the south of 
Europe, but introduced into the gardens of the United States — is ex- 
tensively cultivated for medicinal purposes. The petals are gathered 
before the flower has blown ; are separated from their white claws or 
heels, and dried : they have a velvety appearance ; purplish red colour, 
and bitterish and astringent taste. Their chief constituents, for which 
they are valued in medicine, are tannic and gallic acids, and colouring 
matter. 

Red roses were, at one time, more employed in medicine than at 
present. They are more largely used, too, in Great Britain than in this 
country. Their astringent powers are certainly slight ; but, owing to 
their colour, which they impart readily to water, they form elegant ve- 
hicles for the administration of other remedies. Hence, the infusion of 
roses, although astringent, is a common vehicle for sulphate of magne- 
sia, which is a cathartic. 

INFU'SUI ROSE COMPOS'ITUM, COMPOUND INFUSION OF ROSES. {Basse 
Gallic, ^ss ; Aqua bullient. Oiss ; Acid, sulphuric, dilut. f.Jiij ; Sacchar. 

3iss.) 

The astringency of the red. rose is imparted to the water ; but the 
main agency is that of the sulphuric acid. As above remarked, it is 
used, especially in Great Britain, as a vehicle for sulphate of magnesia, 
the taste of which it partly covers. Sulphate of quinia may, likewise, 
be given in it,— the sulphuric acid dissolving the sulphate, and, at the 
same time, preventing the tannic acid of the roses from precipitating 
the quinia. Like sulphuric acid itself, it may be taken in hemorrhages 
that require the use of astringents, and in. the colliquative sweats of 
hectic. It is also used occasionally as a gargle, associated with alum, 
tincture of capsicum, &c. The dose is from f.|j to f.filj and more. 

CONFEC'TIO ROSE, CONFECTION OF ROSES, Conserve of Roses. (Ros. 
Gallic, pulv. §iv; Sacchar. pulv. 3xxx; Mel. despumat. 5vi ; Aquce 
Vol. II.— 9 * 5 J ' * 



130 SPECIAL ASTRINGENTS. 

rosce f.^viij.) This confection is slightly astringent ; but it is now rarely 
employed excepting as an agent in the formation of pills of active re- 
medies, as calomel, sulphate of quinia, &c. Rubbed up with syrup, 
almond or olive oil, and dilute sulphuric acid, it forms a linctus, which 
is an excellent demulcent expectorant where such is needed. (See 
Oleum Amygdala, Vol. i. 244.) It enters into the composition of the 
Pilulas hydrargyri of the pharmacopoeias. 

MEL R0SJ1, HONEY OF ROSES. {Rosce Gallic. %\] ; Mel. despumat. Oij ; 
Mquce bullient. Oiss, reduced to specific gravity 1.32 by evaporation.) 
This is a very old remedy, employed in sore throat, and ulcerations of 
the lining membrane of the mouth. It is a mild astringent, and is 
occasionally used as a vehicle for more active applications. It is some- 
times added to astringent gargles. 

15. MONE'SIA. 

It is only of late years, that this substance has been known in this 
country. It was introduced from France with high encomiums from 
several distinguished physicians and pharmaciens of Paris. It is im- 
ported into France from South America in cakes or loaves weighing 
upwards of twenty pounds, which consist of an extract, prepared in 
South America from the bark of a tree, whose botanical name is un- 
known. The bark is said to be called, by some travellers, Goharem, 
and by others, Baranhem ; and the botanists who have examined it in 
South America, think that it is derived from a Chrysophyllum, — Ch. 
glycyphlceum, a tree of middling size, which grows in the forests near 
Rio Janeiro and elsewhere in Brazil. The bark is smooth and grayish, 
like that of the plane tree, except that it is much thicker : its sweet taste, 
too, contrasts greatly with the bitterness of the thin lamina? of the plane 
tree. 

Monesia — the extract — is of a deep brown colour ; very soluble in 
water ; and of a taste at first like liquorice, but soon becoming astrin- 
gent ; and leaving behind a well marked and enduring acrid impression, 
which is experienced especially in the tonsils. When subjected to ana- 
lysis by M. Persoz, it was found to contain tannic acid, rendering iron 
blue, 52 per cent. ; gum or mucilage, 10 per cent. ; sweet matter, 36 
per cent. The bark and extract of monesia resemble those of Quillaia 
Saponaria; but they are sensibly different. 

Its action on the economy is that of an excitant and astringent, and 
as such it may be adapted for many pathological conditions in which 
agencies of the kind are indicated. It has accordingly been prescribed 
in various profluvia of an atonic character, — in chronic bronchitis, and 
bronchorrhcea ; chronic diarrhoea and dysentery ; leucorrhcea ; blennor- 
rhcea ; and in asthenic hemorrhages — haemoptysis, metrorrhagia, &c. 

The powdered extract, or an ointment made of it, has been applied 
to ulcers of a flabby and unhealthy character ; and, like every new 
substance brought forward with lofty pretensions, it has been employed 
in affections of a heterogeneous character. It is unquestionably entitled 
to attention as an astringent ; but, already, it has almost passed into 
disuse. 

Monesia is generally given in pills, in the quantity of from 12 to 40 



MATICO. 



131 



grains in the twenty-four hours, — the medium dose being 15 or 20 grains 
taken at twice or thrice. Syrup of Monesia, which is adapted for chil- 
dren, may be made of six grains to the ounce of simple syrup. Tincture 
of Monesia, (Mones. gr. xxxij ; Alcohol, dilut. f.^j ;) may be given. in 
the dose of f-5j to f.3ij in any bitter or astringent infusion. It may also 
be prescribed as an injection in the quantity of f.rj to f.jiss to six fluid- 
ounces of water. An Ointment of Monesia, to be applied to ulcers, 
may be composed of ^j of Monesia to £vij of Lard or Simple ointment. 

16. MATI'GO. 

At the meeting of the Provincial Medical and Surgical Association, 
held at York in August 1841, 

Dr. Jeffreys, of Liverpool, Fi s- 15 °- 

introduced to the profession 
an herb called Matico, used 
in South America as a styp- 
tic ; a short account of which 
appeared in the London Lan- 
cet for Jan. 1839. Since its 
introduction into England, it 
has been frequently used, es- 
pecially as a styptic ; and 
often with apparent success. 
In diseases of the mucous 
membranes and in hemor- 
rhages it has been prescribed 
internally with advantage. So 
long ago as 1834, the author's 
friend, Dr. Ruschenberger, of 
the Navy, brought a specimen 
from South America to the 
United States. It is there 
called Yerba del Soldado, 
Soldier's weed. In Peru, ac- 
cording to a statement kindly 
furnished the author by Dr. 
Ruschenberger, it has a popu- 
lar reputation of being a 
wonderfully powerful styptic ; 
and it is said, that soldiers, 
on going to battle, carry with 
them a supply to stanch blood 
when they receive wounds. 
The leaf is moistened in the 
mouth, and then applied. 

Matico is Jirtanthe elongata, Piper angustifolium of Ruiz and Pavon. 
It is said to contain resin and volatile oil ; but its exact chemical con- 
stituents have not been determined. The specimens examined by the 
author had certainly no marked sensible properties. 

It is chiefly given in infusion of one ounce of the leaves to a pint of 




Artanthe elongata. 



132 



SPECIAL ASTRINGENTS. 



boiling water ; of which a fluidounce and a half is a dose; — and in 
Tincture — two ounces and a half of the leaves to a pint of dilute al- 
cohol ; of which the dose is from one to three fluidrachms, two or three 
times a day. Both solutions may be used as external astringents ; or, 
to stop hemorrhage, the inner side of the leaf may be pressed upon the 
bleeding vessel. As the author has remarked elsewhere, however, the 
difficulty of establishing the action of styptics is considerable, as is 
sufficiently exemplified in the history of the Acqua Binelli and the 
Acqua Brocchieri, (p. 116). The same difficulty exists in regard to 
the determination of its powers as an internal astringent. After the dis- 
charge of an uncertain amount of blood, hemorrhage generally ceases 
spontaneously ; and hence any article, that may have been administered, 
may acquire a haemastatic reputation. This probably is the history of 
the employment of chloride of sodium to check the flow of blood in 
haemoptysis. Doubtless, however, matico is worthy of more extensive 
trials, although its sensible properties, taken alone, would not encourage 
us to place more faith in it than in the overrated haemastatic * waters' 
referred to. {New Remedies, 5th edit. p. 436, Philad. 1846.) 



17. MATIAS or MALAM'BO. 

Malambo bark, the source of which has not been positively deter- 
mined, has been long known 
to, and examined by the 
French pharmaciens. Mr. 
Ure is of opinion, that the 
Matias bark received by 
him from South America is 
identical with it. It is de- 
scribed by him, as three or 
four lines thick, brittle, al- 
though somewhat fibrous; of 
a brown colour, and covered 
with an ash coloured tuber- 
culated epidermis ; has an 
aromatic smell, and a bitter 
pungent taste, which it 
yields to water and alcohol, 
— the former being an agree- 
able bitter infusion, and the 
latter a powerful bitter tinc- 
ture. 

Malambo bark was ana- 
lyzed by M. Cadet, and sub- 
sequently by M. Vauquelin, 
who found ittocontainresin; 
a light volatile oil, and an 
extract very soluble in water. 
No tannic acid was, how- 
ever, found in it; scarcely any gallic acid ; and none of the alkalies of 




Diospyros Virginiana. 



HEUCHERA. 



133 



the cinchonas ; yet in New Granada, where the tree grows, it is held in 
high repute as an antiperiodic and stomachic. 

Mr. Ure affirms, that he has frequently administered Matias bark, 
with good effect, as a substitute for cinchona ; and Dr. Mackay states, 
that he has witnessed good results from its employment in cases in 
which an aromatic tonic was needed. An infusion maybe made of two 
drachms of the bark to a pint of water ; the dose of which is one or two 
fluidounces, repealed two or three times a day, in cases where a bitter 
stomachic is needed. 



Fig. 152. 



Besides agents already described, the Pharmacopoeia of the United 
States has admitted into its secondary list the following astringents. 

18. Dios'pyros, Persimmon. This is the bark of Diospyros Virgini- 
ana ; Sex. Syst. Dicecia Octan- 
dria ; Nat. Ord. Ebenacese ; an 
indigenous tree, well known in the 
southern and middle States ; flower- 
ing in May or June ; and producing 
a berry, which, in the green state, 
is exceedingly astringent ; but, 
when ripe, is sweet, mawkish, 
and cloying. The unripe fruit has 
been recommended in infusion, 
syrup, and in vinous and acetous 
tinctures, by Dr. Mettauer, of Vir- 
ginia. The bark, which is the offi- 
cinal portion, is astringent and 
very bitter ; and is adapted for 
cases in which a combination of 
astringent . and bitter agents is 
needed. 



19. Geum, Water Jivens — the 
root of Geum rivale, described 
under Tonics as indigenous in 
the United States — is often used 
as an astringent in the cases so 
often mentioned already, as re- 
quiring astringents. The dose of 
the powdered root is from 9j to 
3j ; but it is usually employed in 
decoction ; ( Gei l] ; dquae Oj. Dose 
f.3j or f.gij.) 

20. Heuche'ra, Alum root — the 
root of Heuchera cortusa, H. Ame- 
ricana, America?!. Sanicle ; Sex. 
Syst. Pentandria Digynia ; Nat. 
Ord. Saxifrages ; a plant found 
in the middle States, flowering in 




Heuchera acerifolia. 



134 SPECIAL ASTRINGENTS. 

June or July. The root has a powerfully astringent taste, and — as well 
as the roots of other species of Heuchera — may be given in the same 
cases as vegetable astringents in general. 

21. Rhus Glabrum, Sumach. This is the fruit or berries of Rhus 
glabrum, Smooth sumach. Upland sumach ; Sex. Syst. Pentandria Trigy- 
nia ; Nat. Ord. Terebinthaceae ; found everywhere in the United States. 
It is astringent, and is sometimes used in infusion as a gargle in sore 
throat. The inner bark of the root, which also possesses astringent 
virtues, may be used as a collutory in mercurial ptyalism, and various 
forms of stomatitis. 

22. Rubus Trivia'lis, Dewberry Root; and 23, Rubus Villo'sus, 
Blackberry Root ; Sex. Syst. Icosandria Polygynia ; Nat. Ord. 
Rosacea? ; are the roots of well known plauts, whose berries are much 
used as food. The main bitterness and astringency appear to reside 
in the bark of the root. It is rarely given in substance ; but if this be 
desired, the dose may be twenty or thirty grains. It is commonly, 
however, prescribed in decoction, (Rub. trivial, vel R. villos. 3j ; Aqua 
Oiss. Boil to a pint.) Dose, f.3j to f.^ij, repeated according to cir- 
cumstances, in chronic diarrhoea and dysentery, and wherever vegetable 
astringents are indicated. 

24. Rumex Britan'nica, Water Dock ; and 25, Rumex Obtusifo'- 
lius, Blunt-leaved Dock; Sex. Syst. Hexandria Trigynia; Nat. Ord. 
Polygonaceae. The root alone of these docks is officinal. The plants 
are common in the United States; and the roots are possessed of astrin- 
gent and tonic properties. They may be given in decoction, (Rumicis. 
5j ; Aquce, Oj. Dose; f.^j to f.^ij) but are rarely employed. 

Rumex crispus, a common species, is possessed of similar properties. 
Dr. N. S. Davis, of New York, is satisfied, from his experiments and 
observations, that the chief value of dock root " consists in its alterative 
and gently laxative qualities." As an alterative he esteems it to be 
" fully equal to the far-famed sarsaparilla." — Quod est demonstrandum! 

26. Spir^e'a, Hardhack. The root of Spiraea tomentosa ; Sex. Syst. 
Icosandria Pentagynia ; Nat. Ord. Rosacea?. It is astringent and 
tonic, and is employed in the same cases as the last. The best form 
perhaps of administration is the decoction, {Spirace §j ; Aq. bullient. Oj. 
Dose ; f.^j to f.^ij.) 

27. Stat'ice, Marsh Rosemary. The root of Statice Caroliniana ; 
Marsh Rosemary or Sea Lavender; Sex. Syst. Pentandria Pentagynia; 
Nat. Ord. Plumbagineae ; is a powerful astringent; and although not 
much used in Philadelphia, and scarcely to be found in the shops, is 
regularly kept by the druggists in Boston, and other parts of New 
England, where large quantities of it are sold annually. It is certainly, 
according to all testimony, a valuable astringent, and well adapted for 
cases in which the vegetable astringents are prescribed. It has been 



CREASOTUM. 



135 



analyzed by Mr. Edward Parrish, of Philadelphia, and found to con- 
tain, amongst other less important 
matters, 12.4 per cent, of tannic acid 
— a much smaller quantity than exists 
in many other astringents ; with ex- 
tractive matter, to which its bitterness 
is due. 

Decoction would appear to be the 
best form of preparation. 

28. CREASO'TTJM.— CRE'ASOTE. 

•Creasote, whose main properties 
have been described elsewhere, (Vol. 
i. 498,) owing to its power of coagu- 
lating albumen, as well as of exciting 
the vessels, with which it comes in 
contact, to contraction, has been em- 
ployed as an indirect astringent in 
cases of hemorrhage ; and is said to 
have been beneficial in haemoptysis. 
In hsematemesis, too, it has succeeded 
after the remedies, ordinarily pre- 
scribed, had been employed without 
effect. It has been given, also, 
with apparent advantage, as an inter- 
nal remedy, in leucorrhcea, and bron- 
chorrhcea ; and Dr. Elliotson accom- 
plished a cure in two cases of chronic 
glanders, in the course of a few weeks, 
by the sedulous use of an injection of 
a dilute solution, (one drop to a fluid- 
ounce of water,) throw T n up the affected 
nostril, — combined with the internal 
use of the remedy. 

In vomiting, not arising from inflammation or other organic disease 
of the stomach, creasote has been very efficacious ; and even in 
Asiatic cholera and sea-sickness, it appeared to allay the vomiting. 
In the vomiting of the pregnant female, and in that originating from 
nervous excitability, it was equally beneficial. The testimony in re- 
gard to it has, however, been discordant. Drs. Elliotson, Shortt, A. 
T. Thomson, and Christison, consider it to be a valuable means of 
arresting vomiting. Drs. McLeod and Pereira speak doubtfully of it, 
and with Dr. Paris it entirely failed. The author's success has been 
by no means striking. Frequently, it has been devoid of efficacy, 
and in many cases it developed irritability of the stomach, when 
this did not previously exist. To very impressible persons, indeed, 
its odour and taste are extremely repulsive, and apt to produce nausea 
and vomiting. Externally applied, creasote is a valuable styptic. A^ 
It was discovered at a time when Acqua Binelli enjoyed more confi- 




Statice Caroliniana. 



136 SPECIAL ASTRINGENTS. 

dence as a styptic than it does now ; and the fancied probability, that 
the nostrum was indebted to creasote for its virtues, gave rise to many 
experiments with the latter in cases of hemorrhage. When placed in 
contact with a bleeding vessel, it coagulates the albumen of the blood, 
forms a clot, and at the same time causes contraction of the bleeding 
vessel. It has been used extensively as a haemastatic in epistaxis, 
bleeding from leech bites, and hemorrhage from large wounded sur- 
faces ; as an astringent in profuse suppuration, and in excoriations of 
children, as well as in those induced by lying ; in gonorrhoea and leu- 
corrhcea, in ophthalmia tarsi, and in prolapsus vaginae, besides the vari- 
ous morbi externi, mentioned under Excitants, (Vol. i. p. 499, ^ in 
which its remedial agency was rather excitant than astringent. 

The dose of creasote, as an astringent, is one or two drops, several 
times a day, well diffused through mucilage of gum arabic. . It is 
proper to remark, that a fluidrachm contains one hundred and fifty 
drops of creasote. It is best given in the form of pill, with crumb of 
bread and mucilage as the excipients. As a topical application, it may 
be mixed with water, with or without the addition of alcohol. Crea- 
sote water, as it is termed, is usually made with one part of creasote to 
<Yv eighty of water, and it is sufficiently strong for most purposes as a lotion 
or injection ; if not, the strength must be increased. An injection of a 
drachm of creasote to twelve ounces of starch, administered every 
night, has been extolled in camp dysentery. 

A few articles, not in the Pharmacopoeia of the United States, have 
been supposed to owe a portion of their medicinal efficacy to creasote; 
viz : — 

29. Fuli'go, Wood Soot.-^A decoction of this has been used as an 
astringent in the form of injection, in cases of cystirrhcea ; and, it is 
said, with advantage. M. Andre Gibrin took from the chimney two 
ounces of compact soot, broke it up, washed it, and boiled it in a pint 
of water. After filtration, -this was injected into the bladder twice a 
day. It has likewise been used as an injection in cases of chronic in- 
flammation of the mucous membrane of the vagina. 

30. Ac^idum Ace'ticum Empyreumat'icum, Pyroligneous Acid, is 
prepared in chemical laboratories by the dry distillation of wood. The 
chief constituent of this is vinegar. It has been occasionally used in 
affections of the mucous membranes accompanied by discharges ; but 
is more employed as an antiseptic. 

31. Aqua Picis Liq'uid^, Tar water; at one time so much extolled 
by Bishop Berkeley, and of late recommended in phthisis, but more 
especially in chronic bronchitis ; in the latter of which affections it is 
found to act like the generality of excitant expectorants. (See Vol i , 
p. 240 ) It may be made by digesting an ounce of tar in a quart of 
water for eight days, and then filtering. This may be taken with milk, 
to the extent of from eight to twelve fluidounces in the day 

It has likewise been used with advantage as an injection into the 



ALUMEN. 137 

bladder, in cystirrhoea, along with pills of turpentine. The injection 
was made by infusing for a night, in the cold, a pound of tar in ten 
pints of spring water ; filtering and warming the solution before using 
it. Large quantities were injected through an elastic gum catheter, 
which was forthwith withdrawn, and the patient directed to retain the 
injection as long as possible. This was repeated daily. 

For further particulars in regard to the preparation and properties of 
these agents, see the author's " New Remedies." 

II. Mineral Astringents. 

32. ALU'MEN .— ALUM. 

Alum, Potash alum, Sulphate or Supersulphate of alumina, is a 
double salt, consisting of sulphate of alumina and sulphate of potassa. 
It is found native as an efflorescence from certain rocks and soils prin- 
cipally in volcanic countries ; and is termed Native alum ; but is 
chiefly prepared artificially from Alum slate, — a rock which contains, in 
considerable proportion, sulphur, iron and alumina. Either by spon- 
taneous decomposition, or by roasting, the sulphur receives oxygen and 
is converted into sulphuric acid ; whence result sulphate of iron and 
sulphate of alumina. These are obtained in solution by lixiviation ; 
and, to the liquor, sulphate of potassa is added. The sulphate of iron 
is got rid of by repeated crystallization. 

Alum is manufactured in this manner to a great extent in various 
parts of Europe ; whence it was, at one time, exported in considerable 
quantities to this country. Of late years, however, it has been made on 
an extensive scale by the chemists of the United States ; and is suffi- 
ciently pure, as furnished by them, for medicinal purposes. It is, 
consequently, placed in the materia medica list, not only of the Pharma- 
copoeia of the United States, but of those of Great Britain. The 
method of preparation generally adopted in this country consists in the 
direct combination of sulphuric acid with clay. It is made, however, 
in Baltimore on an extensive scale by burning an ore, found at Cape 
Sable on the Magothy river, Maryland, which consists of lignite, clay, 
sulphuret of iron and sand. To the solution, obtained by lixiviating 
the ashes, sulphate of potassa is added ; and crystals are obtained by 
evaporation. (Wood & Bache.) 

As met with in the shops, it is generally in broken fragments of 
crystals ; which are transparent ; colourless ; of a sweetish astringent 
taste, and slightly efflorescent. It usually crystallizes in regular octo- 
hedrons, frequently with truncated edges and angles, and sometimes in 
cubes. The size of the crystals is at times very large. Dr. Christison 
states, that at Hurlet, near Paisley, which has been long celebrated for 
the manufacture of this salt, it has sometimes crystallized in columns 
two feet in length, weighing fifteen pounds, and consisting of a pile of 
octohedrons of great size. It dissolves in from fifteen to eighteen 
times its weight of cold water, and in less than its own weight of 
boiling water. 

Such are the main characters of the alum of the shops. A variety of 



138 SPECIAL ASTRINGENTS. 

alum from Italy, called Roman alum, is covered with a rose-coloured 
efflorescence containing oxide of iron ; and another called Roche or 
Rock alum, from Roccba in Syria, is coloured with rose-pink. These 
are not used in medicine. 

The only impurity, which alum is apt to contain, is oxide of iron: 
the presence of this is detected by precipitating the solution with potassa, 
and redissolving the alumina by an excess of the alkali; — sesquioxide 
of iron is left. 

Alum is a powerful astringent in small doses, and as such is used 
both internally and externally. In large doses, it acts both as an emetic 
and a cathartic. In hseraatemesis, and haemoptysis, it has been given 
in large doses, and, in the former affection especially, with great ad- 
vantage, inasmuch as it can come in contact with the vessels exhaling 
the blood, and act as a styptic. It has been prescribed in all forms of 
internal hemorrhage ; and in all increased discharges from mucous 

. membranes, especially from those of the stomach and bowels. In one 
disease of the bowels, — lead colic, — it has been recommended ; but it 
is not easy to see on what principle. By some, it has been supposed 
to act on the lead presumed to be in the stomach, so as to form an 
inert sulphate of lead ; but this is a mere supposition. On the same 
principle, sulphuric lemonade has been advised. One observer, — M. 
Gendrin — affirms, that he has cured more than three hundred cases by 
administering daily from a drachm to a drachm and a half of sulphuric 
acid diluted in three or four pirits of water ; and it is said to have been 
an efficacious prophylactic against the disease in the. laboratories of 
Paris. The experience of M. Gendrin has been corroborated by that 
of others ; but the same agent has been found entirely useless by some. 
The truth would seem to be, that the disease, in many cases, terminates 
in health undei very simple management. Of thirty-one cases, in which 
nothing but the ordinary tisane of the French hospitals was given for 
twelve days, three were cured by the fourth day ; two between the fifth 
and eighth days ; ten between the eighth and twelfth days, and one on 
the thirteenth day. The remaining cases were subjected, after the 
twelfth day, to purgative treatment, under which they were speedily 
cured. It is said to have wonderful influence in allaying the tormina, 
and nausea and vomiting that attend upon the disease. 

Ithas, likewise, been given freely in the colliquative sweats of 
phthisis, and in diabetes ; but in neither case can it be presumed to act 
more than as a palliative. It appears to be adapted for all affections in 
which powerful astringents are deemed necessary. Its efficacy in hoop- 
ing cough has been highly extolled of late by Dr. Davies of London. 
After a long trial, he says, he is disposed to attach more importance to 
it as a remedy in that disease " than to any other form of tonic or anti- 
spasmodic." He has often been surprised at the speed with which it 
arrests the severe spasmodic fits of coughing, and it has seemed to him 
to be equally applicable to all ages, and almost to all conditions of the 

. patient. The fittest state for its administration is " a moist condition of 
the air passages, and freedom from cerebral congestion ; but an opposite 
condition would not preclude its use, should this state not have yielded to 



ALUMEN. 139 

other remedies. It generally keeps the bowels in proper order, — no 
aperient being required during its use. 

As a topical application, also, it is in extensive use. It enters into 
the composition of astringent gargles and collutories, injections, and 
lotions for the treatment of relaxation of mucous membranes. It is an 
excellent styptic to constringe vessels that are allowing blood to escape 
from them, either by division or transudation ; hence it is used as a 
styptic in hemorrhage from the nose, rectum or vagina, — a solution 
being injected ; or lint, or rags, or sponge moistened with it being in- 
troduced into those outlets. In the first and last affection, the author 
has found it necessary, more than once, to dip moistened lint in pow- 
dered alum and introduce it. A saturated solution forms a good appli- 
cation to leech-bites ; but where the bleeding is obstinate, it may be 
necessary to apply the powdered alum itself. 

As a collyrium, it is often prescribed, and as a wash in inflammations 
in general. When unsuccessful in the early stages it may even aug- 
ment the inflammation ; but after the inflammation has become chronic, 
its agency becomes gradually beneficial, and is exerted in the manner 
elsewhere mentioned of excitant applications. 

It may likewise be used as an astringent wash to ulcers that are 
attended with too copious a secretion ; or that are flabby and ill-con- 
ditioned ; and it is frequently of service in various forms of stomatitis. 

The insufflation of alum has been recommended in cases of diphthe- 
ritis. About a drachm of the fine powder is placed in a tube, and 
blown into the patient's throat. It is, also, occasionally applied by means 
of the finger to the throat, when affected with other forms of inflam- 
mation and ulceration. It appears to possess the property of dissolving 
false membranes, whilst, at the same time, it induces a new action in 
the parts beneath. 

The ordinary dose, as an internal remedy, is from gr. x. to 9ij ; but 
in lead colic it is sometimes prescribed in the dose of £ss to 3ij. It 
may be given in pill, with extract of gentian as an excipient. In hoop- 
ing cough, Dr. Davies gives it to an infant in the dose of two grains 
three times daily ; and to older children in the dose of four, five and up 
to ten or twelve grains, mixed with Syrupus Rhoeados — whose virtues 
do not differ from those of simple syrup — and water. It is seldom dis- 
liked. 

It is sometimes prescribed in the form of Alum whey, which is 
made by boiling 3\j of powdered alum in a pint of milk, and straining. 
The dose of this is a wine-glassful. As a collyrium, it may be used in 
the quantity of one to eight grains dissolved in a fluidounce of rose- 
water; and in injections and lotions the strength must vary according 
to the object which the practitioner has in view. It is occasionally ap- 
plied in ophthalmia in the form of Cataplasma Aluminis of the Dublin 
Pharmacopoeia, which is made by briskly agitating two whites of eggs 
with a drachm of alum. In cases of chronic and purulent ophthalmia 
it is placed between folds of linen and applied to the eye. It has also 
been recommended as a good application to unbroken chilblains. A 
poultice, made of the curd resulting from coagulating milk by means of 
alum, is sometimes used. 



140 SPECIAL ASTRINGENTS. 



33. PLUMBI ACE'TAS.— ACETATE OF LEAD. 

Acetate of lead, Sugar of lead, Acetated Cerusse, Super acetate of lead, 
Saccharum Saturni, is made on the large scale by the manufacturing 
chemist ; and is, therefore, with much propriety, placed in the materia 
medica list of the Pharmacopoeia of the United States. The pharma- 
copoeias of London, Edinburgh and Dublin, however, contain formulae 
for its preparation, which consist in dissolving litharge or protoxide of 
lead, or carbonate of lead, in diluted acetic acid, and crystallizing. On 
the large scale, it is made by hanging lead plates in distilled vinegar or 
diluted pyroligneous acid. A saturated solution of protoxide of lead 
may be formed in this way ; and the acetate is obtained by evaporation 
and crystallization. 

Acetate of lead of the shops appears as a mass of needle-like crys- 
tals, which are transparent, colourless, and belong to the oblique pris- 
matic system. (Pereira.) The taste is at first sweet, and afterwards 
astringent; and has an acetous odour. In a dry and warm atmosphere, 
it slightly effloresces ; and is apt to be decomposed by the carbonic acid 
of the air, and to become partially insoluble. Temperate water dis- 
solves about four-fifths of its weight, according to one observer, (Tur- 
ner;) two-fifths, according to another. It is soluble, likewise, in 
alcohol. When dissolved in water, — owing to the fluid containing car- 
bonic acid, a carbonate of lead is formed, which renders it turbid. This 
may be prevented, however, by the addition of a few drops of acetic 
acid. It is not often adulterated. 

In large doses, acetate of lead is a violent poison of the irritant class. 
In smaller doses^when continued for any length of time, it may give rise 
to the peculiar symptoms of lead-poisoning. Yet it has been repeatedly 
prescribed by the author, and by a large number of respectable thera- 
peutists, in considerable quantities, without the supervention of any 
such results. Its effect upon the system is preceded by a narrow leaden 
blue line, which is seated at the edges of the gums, where they are 
attached to the neck of two or more of the teeth of either jaw. Dr. 
Burton has pointed out this symptom ; and Dr. Pereira states, that in 
every case of lead colic that has fallen under his care, he has observed 
it, and in most of the cases it was accompanied by abdominal pain. 
The view of Dr. A. T. Thomson is, that acetate of lead becomes poi- 
sonous by being converted into carbonate in the stomach, and he affirms 
that if it be associated with vinegar, it may be administered freely, and 
with safety. Dr. C. G. Mitscherlich, however, has shown, that acetate 
of lead is a poisonous salt ; and that when mixed with acetic acid it is 
more energetic than when given in the neutral state. It is now much 
employed as a sedative astringent in various forms of hemorrhage ; and 
alone,' or associated with opium, is highly esteemed by several practi- 
tioners, although in many cases the good effects are more ascribable to 
the general treatment combined with it. It has, also, been freely pre- 
scribed in chronic diarrhoea and dysentery, as well as in cholera, cholera 
morbus, and cholera infantum. Some practitioners have extolled it 
highly in the first of these affections. In phthisis, it has been used, of 



PLUMBI ACETAS. 141 

course only as a palliative, for checking colliquative sweats, and 
diarrhoea ; and both in that disease and in chronic bronchitis, it has 
seemed, according to some, to diminish profuse expectoration. In the 
irritability of stomach, that sometimes forms part of the phenomena of 
remittent and yellow fever, sugar of lead has succeeded when other 
remedies had failed. 

As a topical application it is much employed. It has been used as a 
wash to check profuse ptyalism induced by mercury, and in aphthous 
stomatitis, — care being taken to wash the mouth well afterwards, to 
prevent the teeth from being blackened. It is, likewise, applied to 
inflamed parts — to phlegmonous and erysipelatous inflammation, con- 
junctivitis, &c; and is used as an injection in gonorrhoea, leucorrhcea and 
gleet. Cautions have been given against its use in ulcerations of the cor- 
nea, that attend purulent and pustular conjunctivitis, as it forms a white 
compound, which is deposited in the ulcer, to which it adheres tena- 
ciously, and in the healing becomes permanently imbedded in the struc- 
ture of the cornea. 

The dose of acetate of lead is from one or two grains to six or eight, 
repeated several times a day, in the form of pill, or, as suggested by 
Dr. A. T. Thomson, in diluted distilled vinegar, to prevent its conver- 
sion into carbonate. It is often associated with opium, both for inter- 
nal and external exhibition ; and Dr. Christison affirms, that for erythema 
and erysipelas, one of the best forms, of application is a lotion composed 
of four grains of acetate of lead and four of opium, to every fluid ounce 
of water. A decomposition always takes place, — meconate of lead 
being deposited, and acetate of morphia remaining in solution. The 
author has seen sulphuric acid prescribed as an astringent along with 
acetate of lead, which must have been owing to gross ignorance or 
inadvertence, inasmuch as the sulphate of lead formed is wholly inert. 
When acetate of lead is used as a collyrium, the strength may be from 
one to five grains to a fluidounce of water or rose water. This may 
be dropped between the eyelids, or be applied by means of an appro- 
priate eye-glass ; — or rags constantly wet with it, or a cataplasm of 
crumb of bread, to which it has been added, may be applied to the 
inflamed part. In inflammations of the cutaneous surface it may be 
applied in the same way ; but the lotion may be made much stronger, 
— for example, ten to twenty grains to the fluidounce ; and it may be* 
used in the same proportion, as an injection, in cases of chronic 
diarrhoea and dysentery, and in leucorrhcea. .In gonorrhoea, the strength 
may vary from gr. v to 3ss and more to the ounce. 

LIQUOR PLUMBI SUBACETA'TIS, SOLUTION OF SUBAC "ETATE OF LEAD, Solu- 
tion ofJDiacetateofLead. {Plumb, acetat. 3xvi ; Plumb, oxid. semivitr. 
pulv. §ixss; Aq. destillat. Oiv. Boil for half an hour, adding distilled 
water so as to preserve the quantity. Filter.) Seraivitreous oxide of 
lead, commonly called litharge, is a protoxide of lead ; so that when it 
is'boiled with acetate of lead, a large quantity of it is dissolved, and the 
subacetate results. This has been long known under the name of Gou- 
lard's Extract. As directed by the Pharmacopoeia of the United States, 
it is a colourless liquid ; s. g. 1.267. Carbonic acid— even that which 



142 SPECIAL ASTRINGENTS. 

is contained in water — occasions a precipitate of carbonate of lead, and 
the same result ensues from exposing it to air ; hence it is properly 
directed to be kept in closely stopped bottles. 

Solution of subacetate of lead is used externally only, and in the 
same cases as a solution of acetate of lead. It is rarely employed ex- 
cept in cases of external inflammation, such as that which characterizes 
sprains, burns, or ordinary phlegmonous or erysipelatous inflammation. 
It is always, however, diluted ; and is also directed to be kept in the 
shops in the form of 

LIQUOR PLUMBI SUBACETATIS DILU'TUS, DILU'TED SOLUTION OF SUBACETATE 
OF LEAD, LEAD WATER. {Liq. plumbi subacetat. f.3ij ; Jig. destillat. Oj.) 
This is Goulard's Vegeto-mineral water, Goulard, and is used in the 
cases above mentioned, — cloths being kept constantly wetted, and ap- 
plied to the inflamed parts. 

34. PLUMBI CHLO'RIDUM.— CHLORIDE OF LEAD. 

Chloride of lead is formed when oxide of lead is digested in muriatic 
acid. It falls, also, as a white precipitate, when a salt of lead is added 
to any soluble chloride. In the London Pharmacopoeia, it is directed to 
be formed from acetate of lead and chloride of sodium. 

It is a white crystalline powder,, soluble, according to the London 
College — who have admitted it into their Pharmacopoeia as one of the 
substances employed in the preparation of morphia— in 30 parts of 
water at 60°, and in 22 parts at 212°. 

Chloride of lead acts locally on the tissues as an astringent and caus- 
tic ; and according to some as an anodyne. Mr. Tuson employed it 
with some success, both in the form of ointment and lotion, in cance- 
rous ulcerations. As a lotion, he says, it is of use in producing a 
healthy surface of the sore, removing foetor and relieving pain ; and when 
the ulcer has not been extensive, it has healed % under its application. In 
painful neuralgic tumours, it proved very beneficial in relieving pain. 
When applied to any great extent by rubbing it over the part, in the 
form of ointment, it has produced a numbness of the arm ; and, from 
the observations made by Mr. Tuson in watching the effect of the ap- 
plication, he was induced to think, that the pain was removed by 
paralyzing the nerves of the adjacent parts. He is inclined to believe, 
that when combined with other applications and appropriate internal 
treatment, it may be of considerable service in certain cancerous 
affections. 

A solution may be made of one drachm of the chloride to a pint 
of water — an ointment, of one drachm of the chloride to an ounce of 
simple cerate. 

35. AC'IDUM SULPHU'RICUM.— SULPH'URIC ACID. 

Sulphuric acid— whose properties are detailed under the head of 
Tonics, (Vol. ii. 72,)— is possessed of astringent virtues ; and, as such, 
is frequently prescribed in atonic hemorrhages, especially in those that 



ARGENTI NITRAS 143 

proceed from the lining membrane of the intestines, singly or combined 
with sulphate of magnesia, and under the views given elsewhere, (Vol. 
i. 190). It is also prescribed in the colliquative sweats of phthisis as a q,»/ 
palliative, often associated with opium, {Acid, sulphur, dil., Tinct. opii, 
aa partes sequales. Dose, ten drops every three or four hours.) In 
chronic diarrhoea and dysentery, it has been administered ; but is not 
had recourse to frequently. It is prescribed in the form of 

AC'IDUI SULPHU'RICUM DILUTUM, DILUTED SULPHURIC ACID, (Vol. ii. 
72,) of which the dose is ten drops, three or four times a day, in water, 
or of 

AC'IDUM SULPnU'RICUM AROIAT'ICUM, AROMATIC SULPHURIC ACID, ELIXIR OF 
VITRIOL, (Vol. ii. 72). The dose of this is the same as that of the last. 

Diluted sulphuric acid is sometimes applied externally to arrest capil- 
lary hemorrhage, as in wounds, epistaxis, &c. It is likewise employed, 
when properly diluted, as an astringent gargle in relaxed sore throat, in 
ulcerations of the mouth and throat, and in ill-conditioned ulcers in 
general, — as well as to check ptyalism when profuse. 

36. ARGEN'TI NITRAS.— NITRATE OF SILVER. 

Nitrate of silver, whose properties have been described under 
Tonics, (Vol. ii. 68,) is rarely given internally as an astringent. It is 
sometimes, however, prescribed in chronic diarrhoea and dysentery ; and 
in the follicular affection of abdominal typhus — the typhoid form of 
adynamic fever; and, it is said, with benefit. The author has used it, 
but has not been satisfied that it possessed any special advantage in 
such cases. It may be given either alone or associated with opium. It 
was elsewhere remarked, that whenever nitrate of silver comes in con- 
tact with chlorohydric acid, or a chloride, it is decomposed,— and that 
as the acid exists in health in the stomach, and chloride of sodium is 
present in most of the secretions, chloride of silver must be formed in 
the stomach ; and perhaps the beneficial effects, ascribed to the nitrate 
as an internal remedy, may properly belong to the chloride. Under this 
idea, chloride of silver was given in the wards of the Philadelphia Hos- 
pital by one of the resident physicians, Dr. Perry, and, in his opinion, 
with advantage. The author has also frequently prescribed it ; and on 
the whole it has appeared to him to be equal to the nitrate in chronic 
diarrhoea and dysentery, and in other cases in which the latter is indi- 
cated as an astringent. 

It is, however, as an external astringent that nitrate of silver is most 
employed. Independently of its action as a caustic and powerful topi- 
cal excitant, to be referred to hereafter, it is used as a gently excitant 
astringent in local inflammation, especially of the conjunctiva. It may 
be applied as a collyrium in the strength of a grain or two to the fluid- 
ounce of distilled water; and maybe employed even in the acute stage 
of the inflammation, although it is most decidedly beneficial in the 
chronic stage. It is sometimes used in similar cases in the form of oint- 



144 SPECIAL ASTRINGENTS. 

ment, — from two to ten grains of the nitrate to an ounce of lard, or of 
simple ointment, — and a piece, the size of a pin's head, and even larger, 
being introduced between the eyelids by means of a camel's hair pen- 
cil. Warm fomentations are used at the same time, and the application 
of the ointment is repeated every third day. It is not often employed, 
however, in this mode, in ordinary ophthalmia. In the purulent variety, 
it is prescribed both in the acute and chronic stage ; but especially in 
the latter. In the variety of ophthalmia that affects the tarsi, this oint- 
ment is often highly beneficial, applied by means of a camel's hair 
pencil to the tarsal cartilages. 

A lotion, consisting of from five grains to twenty of the nitrate to 
a fluidounce of water, is often of great advantage in stomatitis and 
pharyngitis accompanied by ulcerations : the solid nitrate is even re- 
quired at times ; and it has been passed over the tongue so as to reach 
the lining membrane of the larynx in chronic laryngitis and that of the 
pharynx in diphtheritic pharyngitis. In cases of chronic diarrhoea or 
dysentery, which appear to be dependent upon ulceration of the rec- 
tum, the lotion may be thrown up in the way of injection. In gonor- 
rhoea and leucorrhcea of the female, nitrate of silver has been used 
both in solution (gr. iij — xx to a fluidounce of water) and in the solid 
state ; but at times, serious inflammation results from the latter form of 
application. In the gonorrhoea of the male, the solution may be used ; 
and occasionally an ointment proves effectual, applied around a bougie; 
but inflammation of the urethra sometimes results from it. (Pereira.) 
By Dr. MacDonnell, of Montreal, a solution has been thrown into the 
bladder in chronic inflammation of that organ and with much success. 
The strength of the solution had seldom to be increased beyond five 
grains to the fluidounce. 

It can be readily understood, that in a variety of ulcers, and chronic 
cutaneous diseases, the excitant effects of this powerful agent may be 
advantageous. The dose as an internal astringent, is from an eighth to 
half a grain, gradually increased to three or more, twice or thrice a day. 
Extract of gentian may be the vehicle. 



The Oxide of Silver has been given by Mr. Lane with success in 
uterine hemorrhage both in the impregnated and unimpregnated state; 
and, Sir James Eyre has strongly recommended it in the treatment of 
profuse menorrhagia. It has likewise been given in leucorrhcea and 
dysmenorrhcea, haemoptysis, heematemesis, hemorrhage from the intes- 
tinal canal and obstinate chronic diarrhoea, and in the profuse purulent 
expectoration and perspiration, of phthisis. Much benefit could scarcely 
however be expected from it in the last mentioned cases. According 
to the experience of Sir James, it is superior to ergot, gallic acid, and, 
indeed, all other remedies. Mr. Lane esteems it to be essentially se- 
dative, and employs it both internally and externally. He recommends 
it in irritable ulcer, chronic ophthalmia ; ulceration of the cornea, with 
thickening of the eyelids; applied in the form of ointment by means of 
a camel's hair pencil. Although neither Mr. Lane nor Dr. Golding 
Bird observed any coloration from its internal use after it had been 



TINCTURA FERRI CHLORIDI. 145 

continued for several weeks ; it is doubtless liable to occasion it. Dr. 
Pereira suggests, that it may be continued for five or six weeks with 
safety. The dose is half a grain three times a day, gradually augmented 
to one or two grains or more. An ointment may be made of from 
twenty grains to a drachm of the oxide to an ounce of lard. 

37. CUPRI SULPHAS.— SULPHATE OF COPPER. 

Sulphate of copper, whose general properties are described elsewhere, 
(Vol. i. 122,) has been advised as an astringent in chronic diarrhoea and 
dysentery, and it is said to have proved successful when the ordinary 
vegetable astringents had failed. Dr. Pereira states, that he has em- 
ployed it with excellent effects in chronic diarrhoea of infants, in doses 
of one-twelfth of a grain. It has likewise been given in increased dis- 
charges from other mucous membranes. 

As an external agent, it is used in the same cases as nitrate of silver, 
and especially in inflammation of the conjunctiva, of the mucous mem- 
brane of the mouth and fauces, and of the genito-urinary apparatus both 
of the male and female. In gangrenous stomatitis, commonly called 
cancrum oris, it has been highly recommended by Dr. B. H. Coates, of 
Philadelphia. Solid, or in solution, it is an excellent stimulant to ill- 
conditioned ulcers ; and superficial ulcerations often heal very readily 
by a single application, either of the sulphate of copper, or of the nitrate 
of silver in substance. This is strikingly the case in the superficial 
ulcerations often caused by stomatitis. 

A strong solution (gr. xx to xxx to the fluidounce of water) is em- 
ployed as a styptic in cases of capillary hemorrhage, as from leech bites ; 
and sometimes the powdered salt is required to repress the flow. The 
dose of sulphate of copper, as an internal astringent, is an eighth or a 
quarter of a grain, made into pill with crumb of bread or extract of gen- 
tian, and given two or three times a day. A grain or two to the fluid- 
ounce of distilled water forms a good excitant astringent collyrium ; and 
lotions may vary in strength from two to fifteen grains or more. The 
lotion, used by Dr. Coates in gangrenous stomatitis, consists of sulphate 
of copper 5ij ; powdered bark 5ss; water f.iiv. 

38. TINCTU'RA FERRI CHLO'RIDI.— TINCTURE OF CHLORIDE OF IRON. 

Tincture of chloride or muriate of iron, described elsewhere as a 
tonic, (Vol. ii. 57,) is likewise a powerful astringent, both when ad- 
ministered internally and externally. In cases of haBmatemesis, it comes 
in contact with the vessels that exhale the blood, and may therefore act 
as an external styptic ; but it has likewise been extolled in hemorrhage 
of the asthenic kind from other parts, as from the uterus and urinary 
organs. It has also proved beneficial in cystirrhoea, and in gleet ; and 
some have presumed, that it may have a ' specific' influence over the 
whole of the urinary apparatus, " for on no other supposition can we 
explain the remarkable effects which it sometimes produces in affections 
of the kidneys, bladder, urethra, and even of the prostate gland ;" yet 
Dr. Pereira, from whose excellent pharmacological work this quotation 

Vol. II.— 10 



146 SPECIAL ASTRINGENTS. 

is made, shows, that such is not the verdict of the profession, and it 
would be strange if it were. It may be averred with confidence, that 
we have not in the lists of the Materia Medica any therapeutical agent, 
which possesses such influence on any organ. Dr. Pereira affirms, that 
he has found the tincture occasionally successful, when given in con- 
junction with tincture of cantharides, in the latter stage of gonorrhoea; 
after a variety of other remedies had failed. It is likewise used as an 
external styptic in capillary hemorrhage, and as a local astringent in 
bleeding ulcers, as well as in those that are accompanied by profuse 
secretion. 

The dose is from ten to thirty minims, which may be gradually aug- 
mented to f.jj or f.Jij twice or thrice a day, in some diluent. 

39. FERRI PERNI'TRAS.— PERNI'TRATE OF IRON. 

A solution of pernitrate of iron — persesquinitrate — Liquor Ferri Per- 
sesquinitratis has been introduced into notice, of late years, chiefly as an 
astringent. It is made by dissolving small pieces of iron in nitric acid, and 
adding a little muriatic acid, to prevent the persesquinitrate formed from 
undergoing decomposition, — according to the following formula. Take 
of small chips or pieces of iron wire, 3iss; nitric acid, f.^iij ; water, 
f.^xxvij ; muriatic acid, f.3> Put the iron into an earthenware vessel, 
and pour on the nitric acid, previously diluted with fifteen fluidounces 
of the water. Set aside until the whole of the nitric acid has united 
with the iron; decant the liquid from the undissolved iron; strain; 
filter, and add the remainder of the water with the muriatic acid ; or as 
much of the water as will make the whole solution thirty fluidounces. 

It resembles tincture of chloride of iron in its medical properties. It 
has been used as an astringent in chronic diarrhoea ; and in affections 
of the mucous membranes that are accompanied by discharges. It has 
been advised in cases of aphthous sores, and is said even to have 
relieved toothache. It is, unquestionably, a powerful astringent ; but 
it is doubtful whether it possess any advantage over tincture of chloride 
of iron. The dose of the solution, prepared according to the form 
given above, is* ten or fifteen drops, gradually increased to twenty or 
twenty-five drops, three or four times a day. It has been considered to 
be especially adapted for diminishing irritability and tenderness of the 
mucous membranes with which it comes in contact. 

40. FERRI SULPHAS.— SULPHATE OF IRON. 

Sulphate of iron — whose chief properties are described under To- 
nics, (Vol. ii. 60,) is an astringent, and as such has been prescribed in 
the cases in which tincture of chloride of iron is indicated. It is given 
internally in all forms of asthenic discharges from mucous membranes; 
and externally is employed in collyria, lotions to inflamed parts in 
general, and injections. ; The dose of the sulphate, as an astringent, is 
from one to five grains, in the form of pill. If administered in solution, 
the water should be boiled to expel the air contained in it, the oxygen 
of which would convert the salt into a persulphate. As a collyriura, 



CRETA. 



147 



a grain or two may be dissolved in a fluidounce of water. Lotions 
may, of course, be made of various strengths to suit the particular case : 
as a general rule, however, from four to ten grains to the fluidounce of 
water will be sufficient. In leucorrhcea and prolapsus ani, the quantity 
of the sulphate may be doubled or trebled. It is not very much em- 
ployed, either as an external or internal astringent. 

41. ZINCI SULPHAS.— SULPHATE OF ZINC. 

Sulphate of zinc — whose general properties have been described 
under the head of Emetics, (Vol. i. 121,) — is occasionally given inter- 
nally, as an astringent, in the same cases as acetate of lead ; but it is 
not very frequently prescribed. It is more often, perhaps, used in chro- 
nic mucous discharges, especially chronic catarrh, chronic gonorrhoea 
and leucorrhcea ; and Dr. Christison affirms, that he has often prescribed 
it with the best effects in obstinate chronic gleet, in doses varying from 
three to six grains, twice or thrice a day. 

It is most frequently used as an external astringent, and as such forms 
a convenient collyrium, more especially in cases of chronic, or puru- 
lent ophthalmia. It is likewise prescribed, as an injection, in gonor- 
rhoea, leucorrhcea, and gleet ; and is applied as a lotion in aphthous 
affections of the mouth, and in relaxation of the uvula, and of the mu- 
cous membrane of the isthmus faucium ; but its disagreeable and 
enduring taste prevents it being much used in the last cases. A solu- 
tion of sulphate of zinc is often applied in external inflammation, and 
as a wash to ulcers attended with too copious a discharge. 

The dose, as an internal astringent, is from gr. j to gr. vj in the form 
of pill. As a collyrium, the proportion may be gr. j to gr. x. to a fluid- 
ounce of water ; — as an injection in gonorrhoea, gr. v to gr. x ; and in 
leucorrhcea, from gr. x to gr. xx. As a wash to ulcers and to external 
inflammations, the proportion may be the same. 

42. CRETA.— CHALK. 

Chalk or native friable carbonate of lime is met with in abundance in 
various parts of Europe ; whence it is exported to this country. It is 
not found native, how T ever, in a state fit for medical purposes ; but re- 
quires washing to separate it from the gritty particles which it contains. 
It then forms CRETA PMPARA'TA of the pharmacopoeias. When pure, it 
is wholly soluble in dilute chlorohydric acid with effervescence ; and 
the solution yields no precipitate with ammonia. It is devoid of taste 
and smell ; is almost insoluble in water, and much more soluble in 
carbonated water. When applied to the tongue, it adheres slightly 
to it. 

It is used as an indirect astringent to the intestinal canal, probably on 
account of its absorbent properties. It certainly diminishes the num- 
ber of alvine discharges ; and, like argil, seems to form with the gastric 
acids salts that are binding. It is much used for checking diarrhoea, 



148 SPECIAL ASTRINGENTS. 

either alone or combined with opium, or with, true astringents,— as kino 

and catechu. 

As a local application, it is dusted on inflamed parts, whose surface 
it covers and protects from the desiccative and irritating action of the 
air. Dusted on excoriations, ulcers, burns, scalds, &c, it appears to 
be beneficial by absorbing ichorous or other discharges. 

When given in powder, the dose is gr. x to 3ss or 3j> frequently re- 
peated. 

MISTFRA CRETjE, CHALK MIXTURE. {Cretce praparat. §ss ; Sacchar., 
Acacia pulv. aa 3ij ; Jiquse Cinnam., Jlquce aa f.^iv.) This prepara- 
tion is very much used in diarrhcEa accompanied with predominance of 
acid. Tincture of opium, or infusion of kino or catechu, is frequently 
associated with it. The dose is f.^ss to f.^ij. 

43. TESTA PR^PARA'TA.— PREPARED OYSTER SHELL. 

This is made by freeing oyster shells from extraneous matter, wash- 
ing them with boiling water, and reducing them to powder by leviga- 
tion. 

Prepared oyster-shell is really only carbonate of lime, intimately 
associated with animal matter. It does not differ, consequently, in its 
medical properties from chalk. The animal matter is supposed, by 
some, to render the carbonate of lime more acceptable to the stomach; 
but it is doubtful whether it possess any such agency. It is still re- 
tained in the Pharmacopoeia of the United States ; but has been ex- 
punged from that of Edinburgh ; and Dr. Christison states, that there 
is no other reason for any British college retaining it, than that in some 
places it is more easily obtained than other forms of carbonate of lime. 

44. LIQUOR CALCIS.— LIME WATER. 

Lime water — which is prepared by pouring a gallon of water on 
four ounces of quicklime, preserving the solution in stopped glass bot- 
tles — is a solution of lime in water; and the object of protecting it 
from the air is to prevent the access of carbonic acid, which would 
unite with the lime, and form a carbonate of lime, that would be depo- 
sited. 

Like chalk, lime water possesses the power of diminishing the num- 
ber of alvine evacuations ; and is therefore employed in cases of diar- 
rhoea, especially when accompanied by acidity. It has, likewise, been 
prescribed in diabetes, and in other cases in which an internal astrin- 
gent is needed. It possesses the power of corrugating and indurating 
animal matters. In vomiting, induced by irritability of the stomach, 
and perhaps owing to- too much secretion of acid, lime water mixed 
with an equal quantity of milk has been one of the best remedies ; and 
Dr. Wood, of Philadelphia, states, that he has found a diet exclusively 
of lime water and milk more effectual than any other plan of treatment 
in dyspepsia, accompanied with vomiting of food. In this case, one 
part of lime water to two or three parts of milk is usually sufficient. 



ARGILLA PURA. 149 

It is used as an injection in gonorrhoea after the active inflammation 
has passed away ; and in ulcerations or increased discharges from the 
bladder. It is, likewise, employed occasionally as a wash to flabby 
ulcers, and to chronic eruptions, — as scabies and porrigo. 

LINIMENTM CALCIS, LIN'IMENT OF LIME. {Aqua Calcis, 01. Lini, aa 
foj-) Liniment of Lime water, Carron Oil, — as it was called, in con- 
sequence of having been first used at the Carron works in Scotland, — 
has long been a favourite application in cases of recent burns and scalds. 
The oil and lime form a soap, which, when smeared over the burnt sur- 
face, prevents the irritating influence of the air ; or if it be applied by 
means of a rag, the areolae of the rag are filled up by it, and the same 
object is accomplished. Lime water probably exerts none of its ordi- 
nary remedial agency in those cases, the effect being mainly mechanical. 

45. ARGIL'LA PURA.— PURE ARGIL. 

Pure argil, Mumina, Oxide of Aluminum, was formerly known under 
the names Armenian Bole, Terra sigillata, &c, and was much em- 
ployed as an astringent in hemorrhages, diarrhoea, dysentery, &c. ; but 
it had fallen into oblivion, when it was again brought forward as an 
efficacious astringent. It is usually prepared by drying sulphate of 
alumina and ammonia, and exposing it for twenty or twenty-five minutes 
to a red heat in a crucible. Sulphuric acid and ammonia are driven off', 
and the argil remains behind in the form of a white powder. It is de- 
void of smell or taste, but communicates a feeling of astringency to the 
tongue. When breathed upon, it exhales an earthy odour. It is in- 
soluble in water; but attracts moisture greedily from the air, and forms 
with it a gelatiniform mass. 

Argil is absorbent ; and therefore, perhaps, an indirect astringent as 
regards the intestinal canal. It certainly diminishes the number of 
alvine evacuations. With the gastric acids, it seems to form salts that 
are binding ; and hence it has been given in the vomiting and diarrhoea 
of children in which there is usually a predominance of acidity. It has 
been associated in such cases with decoction of logwood, {Argil. 3ij ; 
Decoct. Hcematoxyl. f.^iv. Dose, a tea-spoonful.) The dose of pure 
argil for a very young child, in the twenty-four hours, is from 3ss to Jj; 
for older children, from 3j to 3ij- It may be administered in an emul- 
sion. 



250 SEDATIVES. 

IV. SED'ATIVES. 

Synon. Sedantia. 

General observations— Subdivision of sedatives— Definition of sedatives— Modus operandi 
—Thomson's table of sedatives— Mental sedatives— Blood-letting— Its effects— Cautions 
respecting its use— Arteriotomy, phlebotomy, local bleeding— Other sedatives— Contra- 
stimulants — Special sedatives. 

Under the head of Sedatives are included such agents as diminish 
action directly or indirectly. The division comprises some of the most 
important classes of remedies we possess ; and such as are especially 
adapted for most of the numerous cases of acute disease that prove so 
fatal to mankind. On some of them, indeed,— in violent inflammatory 
cases,— entire confidence is reposed ; and, if they fail, farther efforts are 
not likely to be of much service. 

It may be said, that many of the local excitants already considered 
may be employed for the purpose of producing an indirectly sedative 
effect; and such is the case with many ; hence they ar£ used in febrile 
and inflammatory affections ; but their sedative operation is not as 
evident from the commencement as those that are ranked under the 
division of sedatives. In the case of the narcotics classed by the author 
as sedatives, an excitant operation is observable when the agent is ad- 
ministered in a small dose ; and, perhaps, even when given to a larger 
amount, there is always some degree of excitation perceptible on care- 
ful examination ; but this is succeeded so rapidly and predominantly by 
the depressing agency, that the excitant property is disregarded, and 
recourse is had to them in the same manner as if they were sedatives 
proper. These last may be defined— " agents that directly depress the 
vital forces." They are employed, consequently, whenever it is neces- 
sary to diminish preternaturally increased action. By many therapeu- 
tical writers, the class is not admitted ; but there are certain remedial 
agents that cannot be brought under any other head ; — blood-letting, for 
example. Their main effect is, doubtless, exerted, directly or indirectly, 
on the nervous system; and, through this, on other parts of the body. 

The best evidence of the modus operandi of sedatives is afforded by 
the most powerful agent of the class with which we are acquainted- 
hydrocyanic acid. As before remarked, if a drop of pure hydrocyanic 
acid be placed on the tongue of an animal, its poisonous effects are so 
rapidly exerted, that the animal, at times, ceases to breathe almost be- 
fore it can be removed from the lap of the experimenter. Yet it would 
not appear, that the heart and intestines, or even the voluntary muscles, 
have their contractility destroyed in poisoning by this agent ; and Pro- 
fessor A. T. Thomson thinks, that this is true also as regards other 
sedatives. We might, consequently, understand, that if the deleterious 
agency of any sedative were extremely fugitive or evanescent, provided 
we could maintain artificial respiration — effect, that is, the conversion of 
venous into arterial blood — and keep up the circulation, time might be 



DIVISION OF SEDATIVES. 151 

allowed for the system to recover from the deadly influence, and resume 
its wonted action. 

There are other circumstances, which confirm — were any confirm- 
ation needed — the position, that sedatives exert a direct influence on the 
nervous system. When hydrocyanic acid is applied to one limb only 
of a frog, the member becomes paralyzed, whilst the other limbs remain 
unaffected. Robiquet, in executing experiments on the tension of the 
vapour of hydrocyanic acid, after having exposed his fingers to it for 
some time, felt a numbness in them, which lasted for several days; yet 
he experienced no effect from the acid on his system. 

Of the precise nature of the impression made on the nerves by seda- 
tives, we know nothing. The most careful examination exhibits no 
physical alteration of their tissue. It is manifestly not one of excite- 
ment; but on the contrary: all the phenomena, as Dr. Thomson has 
remarked, prove that there are powers which destroy excitability and life 
without previous excitement, or, at least, without any signs of it being 
discoverable. 

The author just mentioned divides sedatives, from the nature of their 
effects, into two distinct classes ; — ' direct sedatives,' or those which 
operate immediately on the nerves, — and ' indirect sedatives,' or those 
which operate through the medium of the vascular system, — as in the 
following table : 

"A. DIRECT SEDATIVES. 

* Organic products. 
a. — Cyanogen — combined with, hydrogen, in 

Hydrocyanic acid. 

Laurel water. 

Volatile oil of bitter almonds. 
combined with potassium, in 

Cyanide of potassium. 
6. — Empyreumatic volatile oil. 

Tobacco smoke. 
c. — Nicotina — contained in the leaves of 

Nicotiana Tabacum. 

** Inorganic substances. 
d. — Sulphur — combined with hydrogen, in 

Sulphuretted hydrogen gas. 

Hydrosulphuret of ammonia. 
e. — Carbon —combined with hydrogen, in 

Carburetted hydrogen gas. 

B. INDIRECT SEDATIVES. 

f. — Carbon — combined with oxygen, in 

Carbonic acid gas. 
g. — Blood-letting. 



152 SEDATIVES. 

To this table might be added the sedation produced by a residence 
in certain localities, combined or not with the use of mineral waters, 
especially of the sulphurous kind, — as at the Red Sulphur Springs' of 
Virginia, the waters of which are reputed to have a wonderful effect 
in reducing the pulse ; and hence the place is a common resort, during 
the summer season, for the phthisical valetudinarian. To the same 
agency might, perhaps, be referred — a residence in mountain gorges, 
and in other situations, where there is a paucity of light, and an absence 
of excitants of all kinds ; and certain emotions, which are of a depres- 
sing or sedative cast, and of which we have so marked an example 
in the nostalgic sadness, which, as before remarked, exerts so deleterious 
an agency on the Swiss, especially when absent from their native 
land. 

Although there may be doubt entertained as regards the action of 
certain sedatives, — whether, that is, the sedative influence be or be not 
preceded by excitation, — there can be none as respects blood-letting. 
Even hydrocyanic acid has been supposed, by M. Magendie and others, to 
produce a transient excitement in the first instance, followed, however, 
immediately afterwards, by an opposite state ; but closer examination, 
added to experiments on animals, seems to exhibit these views to be 
hypothetical. Indeed, there is scarcely sufficient time, in most cases, 
to note any excitation, so rapid is the transition from life to death, when 
the sedative is administered in a state of concentration ; and, when 
more diluted, the effects are clearly of a depressing character. In the 
modus operandi of blood-letting, however, there is nothing equivocal. 
There can be no presumption of excitation before the depressing effects 
are perceptible; yet we can readily comprehend, that there maybe 
states of the system, in which the abstraction of blood, instead of being 
followed by signs of sedation, may give occasion to greater activity of 
vessels, and to a manifestation of greater tone of the system than was 
apparent prior to the operation. Such is signally the case in the fevers 
termed congestive, where the powers of life appear to be depressed, in 
consequence of the accumulation of blood in the internal organs; but 
if the oppressing or depressing cause be removed by the abstraction of 
a due amount of blood, the powers of life develope new energy; the 
blood is regularly distributed through the different tissues and organs, 
and every sign of asthenia disappears. 

The immediate effects of blood-letting on the system are readily ap- 
preciable. The impression is, from the first, one of sedation; and, 
accordingly, it is one of the sedative agents on which our main reliance 
is placed in diseases of excitement. Carried too far, however, it is 
well calculated to develope capillary excitement, in the mode to be 
mentioned presently. At one time, this was an evil which was never 
apprehended ; and if, after excessive loss of blood, hypersemia occurred 
in any organ, or was augmented if it had previously existed, the blood- 
letting was repeated, until the patient sank; the practitioner, not sus- 
pecting the cause of death ; but consoling himself with the reflection, 
that the disease was irremediable, and that he had adopted the only 
judicious course for its removal. 

When an animal is bled to death, it is observed — as the blood flows 



BLOOD-LETTING. 153 

— to become uncertain in its attitude ; and, if it attempts to move, it 
staggers, and ultimately falls. This state is soon succeeded by convul- 
sions, which, in death from hemorrhage, always precede dissolution. 
The same thing happens to the human subject, when death results from 
a rapidly fatal hemorrhage. The rationale of these phenomena would 
appear to be as follows. — As the blood flows from the vessels, the 
great nervous centres cease to receive that supply, which is requisite 
for the due performance of their functions ; hence, the proper amount 
of nervous energy is no longer transmitted to the muscles ; their con- 
traction cannot be energetically maintained ; alternate contractions and 
relaxations in the form of tremors become marked; and, if the flow of 
blood continues, there is not enough nervous influx transmitted to keep 
the extensors in a state of contraction ; the animal consequently falls, 
and, unless the hemorrhage be now arrested, death is inevitable. The 
same inadequate supply of blood to the brain gives rise to irregularity 
of action in the cerebro-spinal axis; and hence convulsions. 

Where hemorrhage takes place, naturally or artificially, to a less ex- 
tent than this, and the individual recovers, a chain of analogous pheno- 
mena supervenes, with w r hich it is important for the therapeutist to be 
acquainted. It would seem, indeed, that whenever the vital fluid is 
lost beyond a certain amount, — and in particular habits this amount 
need not be large, — a series of phenomena present themselves, or are apt 
to present themselves of a nervous kind,, or dependent upon the loss of 
balance between the nervous and sanguiferous systems. Uterine he- 
morrhage aflbrds the best example of the effects of great loss of blood 
in the human subject; although too many cases of mischief from the 
lancet of the practitioner are met with. When blood is discharged to 
an inordinate extent from the uterus, a feeling of faintness is sooner or 
later experienced ; impaired vision and depraved audition,— in the form 
of tinnitus aurium, or other unusual noises, — supervene ; and, if the 
hemorrhage be not arrested, fatal syncope ensues ; generally preceded 
by more or less convulsive movement. If the patient recovers, it 
rarely happens that restoration is effected without symptoms presenting 
themselves, which are referable to the effect produced by the loss of 
blood on the nervous system. In the course of a few hours, although 
the female may have been, to all appearance, exanguious, she may be 
found complaining of violent headache, suffused face, with throbbing 
of the temporal and carotid arteries; yet these symptoms, as elsewhere 
remarked, are certainly not referable to a condition of the blood or of 
the blood-vessels, which farther blood-letting is capable of remedying. 
The mischief has been induced by loss of blood, and farther abstraction 
of that fluid could scarcely fail to add to the morbid condition. 

A case, exhibiting the difficulty of distinguishing, without extreme 
care, whether the state of reaction be one of sthenia or asthenia, was 
exhibited, not many years ago, in an institution of which the author was 
one of the physicians. A man, whose leg had been amputated, was 
found one morning almost exanguious from the giving way of an artery. 
In a few hours, however, he recovered, and was seen by an experi- 
enced colleague, now no more, in the state of reaction, who was unac- 



154 SEDATIVES. 

quainted with the history of the case, and, as soon as he placed his hand 
upon the pulse, inquired why the surgeon did not bleed him ! 

It may be laid down, perhaps, as a general law, that when blood is 
lost to a considerable amount, the great nervous centres receiving an 
inadequate — and the rest of the nervous system an irregular — supply 
their excitability becomes largely and irregularly developed ; so that, 
under this impressible condition of the nerves, the blood-vessels, 
whose functions are modified by them, assume augmented action ; and 
if, owing to the previous existence of hypereemia in any organ, the 
nerves proceeding to that organ are in a morbidly excitable condi- 
tion, a fresh development of excitability may ensue after the bleed- 
ing ; and the hypersemic condition, instead of being relieved by the 
loss of blood, may be augmented by it. In individuals, whose nervous 
system is very impressible, the same effects may be induced by a full 
bleeding as have been described to result from excessive discharges 
from the uterus; and, accordingly, where hypersemic conditions occur 
in such individuals, the practitioner is cautious in the use of the lancet; 
and if he employs it, he does not carry the depletion so far as to depress 
too much the powers of the system, — aware, that if he should do so, 
under the nervous irritability or neuropathia, which he developes, re- 
action might succeed to such an extent as to reproduce the exaltation 
of organic actions in the part, and perhaps to a greater degree than 
before the operation. It is in such impressible habits, that advantage 
is found in the adoption of other sedative agents; and that a combina- 
tion of blood-letting, short of inducing syncope, with a full sedative 
dose of opium, is often so serviceeble ; — the bleeding diminishing the 
exaltation of the vital manifestations, by acting on the nerves through 
the blood-vessels ; and the opium preventing the subsequent develop- 
ment of nervous excitability. In strong individuals, the same plan, 
pushed to a still greater extent, is equally successful and not the less 
philosophical, when employed for the removal of internal inflamma- 
tions. It is the plan which, as before observed, is adopted with so 
much success, in acute peritonitis; — the bleeding being carried so far 
as to make a decided impression on the system, and the opium adminis- 
tered in a full dose ; a sedative influence is thus exerted on the body 
generally, and on the inflamed tissue in particular, under which the 
hyperaemia is effectually subdued. 

Along with his friend, Professor N. R. Smith, of the University of 
Maryland, the author attended a case, in which many of the ordinary 
signs of inflammation of the encephalon were present; yet both were 
satisfied, that great mischief would have resulted from copious abstrac- 
tion of blood. The patient was a nervous female, who, soon after 
delivery, was attacked with excruciating cephalalgia, with the greatest 
intolerance of light and sound, so that every precaution was necessary 
to shut off those irritants. Along with this great impressibility, how- 
ever, the tongue was moist; and the circulation, though hurried, not 
augmented in force. She was bled ; but the symptoms were in no 
respect relieved. The operation was repeated to a trifling extent: so 
much palpitation and nervous turmoil were, however, induced by it, 
that it was not practised a third time ; but leeches were subsequently 



BLOOD-LETTING. 155 

applied to the epigastric region, for the removal of accidental gastro- 
enteric symptoms. This state of excitability of the encephalon con- 
tinued for weeks ; and at length yielded to time and quiet, rather than 
to any particular system of medication ; and under the cautious reap- 
plication of light and noise to the optic and auditory organs, they be- 
came gradually accustomed to the stimulus, and the recovery was 
ultimately complete. Had depletion been carried to a greater extent 
in this case — as it would most certainly have been, by those practi- 
tioners, who believe that blood-letting is the only agent, that can be 
relied on as an antiphlogistic — great mischief would have, doubtless, 
resulted. Long, indeed, before Dr. Marshall Hall published his in- 
teresting u Researches on the effects of loss of blood ," the author had 
been deeply impressed with what appeared to him to be the faulty 
views, entertained both as regards the pathology and the therapeutics 
of such cases as those mentioned ; and had satisfied himself, that the 
maxim, inculcated by many practitioners as applicable to internal in- 
flammations in general — " when you have bled in inflammation to such 
an extent, that you are doubtful, owing to the persistence of the symp- 
toms, whether you should bleed again, — bleed" — was unphilosophical ; 
and often, it was to be feared, attended with disastrous consequences. 
-Asa general rule, the author would say, on such occasions of doubt 
and difficulty, — " do not bleed, but have recourse to some other appro- 
priate sedative, or revulsive agent, until your doubt is removed." 
Every practitioner, much engaged with the diseases of women, must 
have met with cases of peritoneal inflammation in the puerperal state, 
in which, after bleeding has been practiced as far as he has esteemed 
it safe, the effects of a sedative dose of opium have been signally salu- 
tary. The irritability of the nervous system has been allayed ; whilst 
there has been great reason to believe, that if the bleeding had been 
repeated, it might have been formidably developed. 

It is only in comparatively late years, that the attention of therapeu- 
tists has been directed to a pathological condition giving rise to pheno- 
mena of ordinary occurrence, which, in one of the cases, ought to have 
been suspected earlier, from the effects, which we see developed, by 
loss of blood, on animals as well as on man. This occurs in certain 
encephalic affections, which were at one time — and are even now, by 
many therapeutists — considered to require imperatively loss of blood, 
generally or locally, or both. Coma and convulsions were once re- 
garded as invariable evidences of congestion of the encephalic vessels; 
although what was precisely meant by the term, as employed by many 
writers, is not apparent; — whether, for example, the congestion was 
looked upon as an accumulation of blood in the vessels of the brain, 
produced by too great activity of the encephalic arteries ; or as a remora 
of blood in the veins, owing to some asthenic or mechanical cause, 
seated in the veins themselves, or in the parts in which they creep. 
Both conditions were, however, considered to indicate blood-letting ;— 
whether the turgescence, in other words, was active or passive, the 
abstraction of fluid was thought to be demanded. It is now known, 
that coma may exist independently of any fulness of the vessels of the 
encephalon ; that it occasionally appears to be induced by a condition 



156 SEDATIVES. 

the opposite to this ; and that the administration of excitants may be 
required for the removal of symptoms, closely resembling such as are 
cured by bleeding and by ordinary. depletives. 

The precise condition of the brain during sleep has been an interest- 
ing topic of discussion with the physiologist, and is yet sub lite ; but 
it may, perhaps, be unhesitatingly determined, that it is not directly de- 
pendent upon a modified circulation of the encephalon ; and that it is 
altogether a phenomenon of the neurine itself. Coma, being morbid 
sleep, cannot be wholly likened to that which occurs naturally. It is 
frequently the result of pressure made on the cerebral substance by 
vascular turgescence, or effusion ; but it may, and doubtless, does, occur 
from conditions of the cerebral structure itself; and it by no means 
follows, that these must be conditions of turgescence or excitement. 
Dr. Gooch has an excellent chapter on this subject in his work on '-Some 
Diseases Peculiar to Women? It is entitled, " Of some symptoms in 
children erroneously attributed to congestion of the brain :" these he 
regards as dependent rather upon loss of nervous power. "I am 
anxious," he says, " to call the attention of medical men to a disorder 
of children, which I find invariably attributed to, and treated as, con- 
gestion or inflammation of the brain, but which, I am convinced, often 
depends on, or is connected with, the opposite state of circulation. It 
is chiefly indicated by heaviness of head and drowsiness; the age of the 
little patients whom I have seen in this state, has been from a few 
months to two or three years ; they have been rather small of their age, 
and of delicate health ; or they have been exposed to debilitating 
causes. The physician finds the child lying on its nurse's lap, unable 
or unwilling to raise its head, half asleep, one moment opening its eyes, 
and the next closing them again, with a remarkable expression of lan- 
guor. The tongue is slightly white ; the skin is not hot ; at times the 
nurse remarks that it is colder than natural ; in some cases there is at 
times a slight and transient flush : the bowels I have always seen already 
disturbed by purgatives, so that I can scarcely say what they are when 
left to themselves: thus the state which I am describing is marked by 
heaviness of the head and drowsiness, without any signs of pain, great 
languor, and a total absence of all active febrile symptoms. The cases 
which I have seen have been invariably attributed to congestion of the 
brain, and the remedies employed have been leeches and cold lotions 
to the head, and purgatives, especially calomel. Under this treatment 
they have gradually become worse, the languor has increased, the de- 
ficiency of heat has become greater and more permanent, the pulse 
quicker and weaker, and at the end of a few days, or a week, or some- 
times longer, the little patients have died with symptoms apparently of 
exhaustion." 

" The children, who were the subjects of this affection, and were 
thus treated," says Dr. Gooch, " died, not with symptoms of oppressed 
brain, but with those of exhaustion ; and, on examining the head after 
death, the blood-vessels were unusually empty, and the fluid in the ven- 
tricles rather in excess ; in two instances, death was preceded by 
symptoms of effusion, viz., blindness, a dilated pupil, coma and con- 
vulsions ; and after death the ventricles were found distended with fluid 



BLOOD-LETTING. 157 

to the amount of several ounces, the sinuses and veins of the brain 
being remarkably empty. I believe the prevalent notion of the profes- 
sion is, that all sudden effusions of water into the brain are the result of 
inflammatory action ; but, putting aside for a moment this dogma of the 
schools, consider the circumstances of this case. For several days be- 
fore death, all that part of the circulating system, which was cognizable 
to the senses, was at the lowest ebb consistent with life, and after death 
the blood-vessels of the brain were found remarkably empty of blood, 
and the ventricles unusually full of water. From such facts I can draw 
no other inference than this, that this sudden effusion was a passive 
exudation from the exhalants of the ventricles, occasioned by a state of 
the circulation the very opposite to congestion or inflammation. This is 
corroborated by the dissection of animals which have been bled to 
death. Drs. Saunders and Seeds, of Edinburgh, found that in animals 
bled to death, whether from veins or arteries, there was found more or 
less. of serous effusion within the head, and Dr. Kellie thus expresses 
himself: — " If instead of bleeding usque ad mortem, we were to bleed 
animals more sparingly and repeatedly, I have no doubt that we should 
succeed in draining the brain of a much larger quantity of its red 
blood ; but in such experiments we shall, I think, find a larger effusion 
of serum." 

" It is surely impossible" — he adds — "for the reader to mistake me 
so far as to suppose that I am denying the important practical truths, 
that heaviness of head and drowsiness of children commonly depend on 
congestion, and are to be relieved by depletion, and that acute hydro- 
cephalus is a serous effusion, the result of inflammation, and capable of 
being cured only in the inflammatory stage by bleeding and purging. 
These vital truths I would state as strongly as any man, but there are 
opposite truths. All that I mean is, that these symptoms sometimes 
depend, not on congestion, which is to be relieved by bleeding, but on 
deficient nervous power, which is to be relieved by sustaining remedies. 
All I advise is, that not only the heaviness of head and drowsiness 
should be noticed, but the accompanying symptoms also, and that a 
drowsy child, who is languid, feeble, cool, or even cold, with a quick, 
weak pulse, should not be treated by bleeding, starving, and purging, 
like a drowsy child who is strong, plethoric, has a flushed face, perhaps 
swelled gums, and a heated skin. The cases which I have been de- 
scribing ' may not improperly be compared to certain species of plants, 
by no means uncommon, which are liable to be confounded with others 
by an inattentive observer.' " 

These remarks are cited at some length, in consequence of their 
marked accordance with the views, which the author has been led to 
entertain in what have appeared to him to be similar pathological con- 
ditions; and, he is satisfied, that both in children and adults, an analo- 
gous state of the brain is often met with, especially in scarlatina. In 
the disturbed state of the encephalic functions, which so often attends 
that anomalous disease, there may be recognized — it has appeared to 
him — a condition very different from that which is produced by active 
inflammation or congestion of the encephalon. Under the great expen- 
diture of nervous energy, which takes place over the whole system, the 



158 SEDATIVES. 

cerebro-spinal nervous centre appears at times to be in a state very 
different from that of inflammation or active congestion. It is rather 
exhausted ; and, accordingly, in many such cases, the use of diffusible 
excitants has been found serviceable, — the delirium or the coma gra- 
dually disappearing as the system begins to feel their compensating 
influence. This practice was adopted in scarlatina, when accompanied 
by such signs of encephalic disorder, with great success, by Dr. Baer, 
of Baltimore ; and it has been followed by happy results in some cases 
that have fallen under the author's own care. Under the vigorous use 
of depletives, the symptoms have not been mitigated ; at times, indeed, 
they have seemed to be aggravated ; but on changing the system of 
treatment, and having recourse to tonics or excitants, a marked amelio- 
ration has ensued. 

Convulsions were, at one time, universally referred to the same con- 
dition of the encephalon as was presumed to prevail in cases of coma: 
blood-letting was, therefore, the remedy almost always deemed proper; 
yet some misgivings ought to have been produced by the well known 
fact, already referred to, that death from hemorrhage is preceded by 
convulsions. 

Amongst the immediate effects of loss of blood, Dr. Marshall Hall 
enumerates, — syncope, convulsions, delirium, coma and sudden disso- 
lution; — and, amongst the more remote, excessive reaction, sometimes 
with,— -first, delirium, mania ; secondly, coma, amaurosis, or deafness, 
and the sinking state. Convulsion, he properly considers to be, after 
syncope, the most familiar effect. "It constitutes," he adds, "one 
species of puerperal convulsion ; and should be accurately distinguished 
from other forms of this affection, arising from intestinal or uterine irri- 
tation, and an immediate disease of the head." 

The fact of the copious effusion of blood, with the attendant signs of 
exhaustion, will enable the practitioner to discriminate these cases, and 
not to pretermit the use of those energetic agents, which are indispen- 
sable for the safety of the patient, when the convulsions are induced by 
the condition of the gravid uterus modifying the due circulation of blood 
in the brain. It is not in such cases, that the use of the lancet does 
harm ; on the contrary, it is the anchor of safety, and cannot be post- 
poned. The mischief is here owing to the circulation in the brain 
being modified, so that the nervous system is thrown into irregular ex- 
citement ; and nothing will obviate this condition, except diminishing 
the circulatory current. Far different, however, the author is satisfied, 
is the case in the generality of convulsions, which happen during early 
childhood. Prior to the period of the first dentition, owing to certain evo- 
lutions of organs, the nervous system — as previously shown — is unusually 
impressible, so that intense irritation, existing any where, may be the 
occasion of irritative irradiations proceeding in all directions, until the 
parts of the cerebro-spinal axis have their functions deranged ; and sen- 
sation, volition, and mental and moral manifestations become, for the 
time, suspended. In this manner, the irritation produced by the pres- 
sure of a tooth against the gum, or any source of excitation in the in- 
testinal canal, may become the cause of convulsions ; and after the 
functions of the cerebro-spinal axis have been once deranged as they 



BLOOD-LETTING. 159 

are during convulsions, they are extremely prone to re-assume the mor- 
bid condition; until, ultimately, organic disease of the encephalon 
supervenes ; or the little sufferer is worn out by continued irritation. 
In such a case, the predisposition to the disease is the period of life ; 
and the exciting cause is the irritation in the alimentary tube. Great 
impressibility of the nervous system is present even in health ; and this 
impressibility only requires the application of a sufficient exciting cause 
to have convulsions developed. 

In addition to the general predisposition derived from time of life, 
there is doubtless an organization obtained from progenitors, which pre- 
disposes to convulsions. It is not very unusual for a whole family to 
be subject to them during childhood ; and, on inquiry, it may be found, 
that one of the parents was liable to the same disease in childhood. In 
such cases, a less energetic exciting cause is able to develope the mis- 
chief, possessing, as the subjects do, a double source of predisposition. 
In them, we cannot suspect the existence of polyeemia, or hyperaemia 
of the encephalon. The phenomena are wholly neuropathic. The 
predisposition is unusual nervous impressibility ; the exciting cause is 
often situate in the digestive tube ; and very frequently the source ot 
irritation is food of an improper charccter, or an inflammatory or other % 
morbid condition of the mucous or lining membrane. The indication 
cannot, consequently, be to diminish the quantity of blood in the sys- 
tem, with the view of removing any supposititious congestion of the 
encephalon. Blood-letting, in such a state, could hardly fail to add to 
the impressibility of the nervous system ; and it has often appeared to 
the author to be followed, too manifestly, by augmentation of the symp- 
toms. The convulsions have recurred ; the surface has become cool, 
and pale, — almost exanguious ; the circulatory forces have exhibited, 
that their action was enfeebled ; the child has continued in a state of 
coma between the fits, or has had but short intervals of consciousness ; 
and has gradually sunk, with no signs of hyperemia, — unless we con- 
sider the convulsions and the coma to indicate such a condition ; for, 
on dissection, no morbid appearances have been met with in the brain, 
or an effusion of serum has been discoverable, which, as before shown, 
is present, when a healthy animal is bled to death. 

Proceeding on those pathological principles, the author has not often 
considered it proper to abstract blood in the convulsions of infancy : in 
almost all cases, he has found it but necessary to clear the alimentary 
tube by a gentle emetic, followed by a mild cathartic ; to keep the 
child from every source of irritation, that might act injuriously on the 
organs of sensation from without, or on the nerves of the intestinal 
raucous membrane from within ; to equalize, as far as practicable, the 
excitability of the cutaneous surface by the use of frictions or of the 
warm bath ; and, under this plan of management, he has almost always 
found the affection eventuate favourably. At the same time, it is pro- 
per to remark, that there are cases of convulsions accompanied by 
every sign of vascular excitement ; and where a true polysemic or hy- 
peraemic condition of the brain exists. In these, of course, blood- 
letting is the main agent to be relied on. If encephalitis be present, 
it must be treated as such ; but, in all cases, careful attention must be 






160 SEDATIVES. 

paid to discriminate, whether the convulsions be accompanied or pro- 
duced by a redundancy, or by a deficiency, of nervous and vascular 
energy. 

If blood-letting, then, be capable of exerting a sedative agency on 
the organism ; and yet, if carried too far, or not appropriately practised, 
it may give rise to all those mischiefs that follow excessive loss of 
blood, it becomes an interesting topic of inquiry how to regulate the 
operation, where it is needed, so as to have the sedative agency with- 
out any of its unpleasant concomitants, and sequelse. 

When blood is drawn in cases of internal inflammation, the great 
object is, by diminishing the amount of fluid circulating in the vessels, 
to depress the vital manifestations. But the effect of copious blood- 
letting, it has been seen, is exerted greatly upon the nervous system. 
Moreover, as already remarked, when loss of blood takes place—either 
naturally or artificially — to too great an extent, irregular actions are apt 
to supervene ; and as, where hyperemia exists, there is a part of the 
nervous system morbidly impressible, the vessels of the inflamed part 
resume their inordinate action, and the hyperemia, after a full bleeding, 
is speedily reproduced; and, perhaps, to an equal degree. We have 
obviously, therefore, to be careful not to carry the abstraction of blood, 
in such cases, to an extent that may develope irregularities of nervous 
action. 

But this excitability varies materially according to individual organ- 
ization ; and to the character and intensity of the hypersemia. There 
are some persons who faint at the sight of blood ; and who are thrown 
into nervous erethism by an ordinary bleeding; whilst others bear the 
loss of a large amount of blood without the supervention of syncope, 
or seeming to suffer materially. In certain diseased conditions, again, 
the toleration is considerable ; and a delicate female often bears a large 
loss of the vital fluid, when a few ounces in health, or in a different 
affection, would have developed great nervous impressibility. The 
toleration, too, varies somewhat in the same individual. Dr. Thomson 
says he has witnessed cases of decided inflammation, in which syn- 
cope occurred after three or four ounces of blood were taken ; yet, on 
repeating the operation in a few hours afterwards, from twenty to thirty 
ounces were abstracted without the least evidence of its approach. The 
author has more than once had occasion to confirm this ; and it is a 
therapeutical fact of importance,— because if we were to be deterred from 
repeating the blood-letting, owing to the want of toleration at the first 
attempt, we might deprive ourselves of the use of one of the most valu- 
able, indeed, often indispensable, antiphlogistics ; yet, it appears scarcely 
philosophical, that in a case of excited organic actions of a part, — say, 
of the pleura, or peritoneum, — we should take away blood from the 
arm ; or, in other words, from the whole system, in order to reduce the 
overaction of a part. We have no mode, however, of reaching the 
affected vessels, — no mode of applying our remedies to the parts con- 
cerned, — and are compelled to act on the diseased organ through the 
influence which we are capable of producing on the nervous system 
generally, as well as through the diminution in the supply of fluid to 
the inflamed part, which must necessarily result from the operation. 



BLOOD-LETTING. 



161 



From the great amelioration of the symptoms of inflammation, gen- 
erally observed when syncope is induced from any cause, it has been 
deemed important, that blood-letting should always be pushed so far as 
to make this decided impression on the system ; and there are some 
who regard its supervention as an evidence that the operation has 
exerted its full effect, although a few ounces only may have been ab- 
stracted. The author recollects a case in which fainting was occasioned 
by the awkward and abortive attempts of a bungling provincial practi- 
tioner in France ; yet it was regarded by him to be as effectual for the re- 
moval of the hyperemia, for which it was employed, as if twenty or thirty 
ounces had been taken before the occurrence of syncope. The state of 
fainting is one of suspended animation, — of suspension of the great vital 
functions, — and, therefore, one in which there must be a truce to the 
various excited actions, that may be going on in any part of the organ- 
ism ; but the effect is only temporary ; and, as soon as the functions of 
respiration, circulation, and innervation are restored to the normal con- 
dition, the signs of hypersemia may be as manifest as before. By many, 
indeed, syncope has been compared to the cold stage of an intermit- 
tent ; and reaction, it is conceived, is as sure to follow as the hot stage 
succeeds to the cold stage of a paroxysm of that disease. 

" The morbid effects of large depletions," says an able writer and 
observer, Dr. Copland, $ will necessarily vary with the nature of the 
disease in which they are employed. When carried too far, in case of 
excitement, where the nervous or vital power is not depressed, and the 
blood itself rich or healthy, reaction generally follows each large deple- 
tion, and thus often exacerbates or brings back the disease for which it 
was employed, and which had been relieved by the primary effects of 
the evacuation. This is more remarkably the case in acute inflamma- 
tions of internal viscera, particularly of the brain or its membranes. 
Thus, every observing practitioner must often have noticed, that a large 
depletion, when carried to deliquium, will have entirely removed the 
symptoms of acute inflammation when the patient has recovered con- 
sciousness ; and that he expresses the utmost relief. But it generally 
happens that the inordinate depression — the very full syncope that is 
thought essential to the securing of advantage from the depletion—is 
followed by an equally excessive degree of vascular reaction, with which 
all the symptoms of inflammation return ; and the general reaction is 
ascribed entirely, but erroneously, to the return of the inflammation, 
instead of the latter being imputed to the former, which has rekindled 
or exasperated it, when beginning to subside. The consequence is, 
that another very large depletion is again prescribed for its removal ; 
and the patient, recollecting the relief temporarily afforded him, readily 
consents. Blood is taken to full syncope, — again relief is felt, — again 
reaction returns, — and again the local symptoms are reproduced ; and 
thus large depletion, full syncope, reaction, and the supervention on the 
original malady of some or all of the phenomena described above as the 
consequence of excessive loss of blood, are brought before the practi- 
tioner, and he is astonished at the obstinacy, course, and termination of 
the disease; which, under such circumstances, generally ends in drop- 
sical effusion in the cavity in which the affected organ is lodged ; or in 
Vol. II. — 11 



162 SEDATIVES. 

convulsions, or in delirium running into coma ; or in death, either from 
exhaustion or from one of the foregoing states ; or, more fortunately, in 
partial subsidence of the original malady, and protracted convalescence. 
Such are the consequences which but too often result, — which I have 
seen on numerous occasions to result, — when blood-letting has been 
looked upon as the only or chief means of cure — the ' sheet- anchor"* of 
treatment, as it too frequently has been called and considered during 
the last twenty years." 

To prevent this reaction, Dr. Copland directs the following course of 
practice, when large blood-lettings are required in the treatment of vis- 
ceral inflammation. The patient should be either in bed or on a sofa 
and in the sitting or semi-recumbent posture, supported by several pil- 
lows. The blood is to be abstracted in a good sized stream ; and the 
quantity should have some relation to the intensity and seat of the dis- 
ease, and the habit of body and age of the patient, but chiefly to its 
effects : it should flow until a marked impression is made upon the 
pulse, and the countenance begins to change. Farther depletion must 
not now be allowed ; but the finger should be placed on „the orifice of 
the vein, the pillows be removed from behind the patient, the recumbent 
posture be assumed, and the arm secured. "Thus, a large quantity of 
blood maybe abstracted, when it is required, without producing full 
syncope, which should always be avoided : and when a large loss of 
this fluid is either unnecessary, or might be hurtful, the speedy effect 
produced upon the pulse and countenance by the abstraction of a small 
quantity will indicate the impropriety of carrying the practice farther. 
In this manner I have often removed about forty ounces of blood, where 
large depletion was urgently required, before any effect was produced 
upon the pulse, but always carefully guarding against syncope; and by 
the subsequent means used to prevent reaction, no farther depletion has 
been required." 

The " means" alluded to, consisted of contra-stimulant doses of tar- 
trate of antimony and potassa ; of full doses of calomel, antimony, and 
opium; or opium singly, &c. &c. 

There can be little doubt, that the course here recommended is judi- 
cious. The author has already remarked, that in many nervous indi- 
viduals, syncope may be induced, even before the blood flows, or when 
a very small quantity has been discharged. In such case, everything 
is favourable for the occurrence of violent reaction ; and no good is to 
be expected from the temporary sedation effected during the syncope. 
The exaltation of the vital forces, to be permanently subdued, generally 
requires a copious abstraction of fluid from the vessels, and by keeping 
the patient in the horizontal attitude, and waiting for a time, — pressing 
the finger on the vein when signs of syncope appear, and, after they 
have passed away, removing the finger from the bleeding orifice,— blood 
enough can generally be withdrawn to produce the necessary effect. 
At other times, the loss of very large quantities of blood is borne with- 
out the supervention of any evidences of syncope, and when there has 
been great Reason to believe that the toleration would continue, until a 
slight additional abstraction of blood might induce a state of irretrievable 
collapse,— or, what Dr. Marshall Hall has called—" the sinking state." 



BLOOD-LETTING. 



163 



In the lectures of Mr. Lawrence, as given in the London " Lancet " is 
contained the case of a young female, of slender habit, from whom 
ei^ht-and -forty ounces of blood were taken away without fainting. The 
blood still continued running in a vigorous stream without touching the 
surface of the arm ; and it was stopped at that amount only because 
the quantity seemed to Mr. Lawrence to be so very great. In a case 
like this, it would not be right to continue to bleed until signs of syn- 
cope ensue. When the practitioner has bled to thirty, or at the farthest, 
to forty ounces, it would, perhaps, be wise to tie up the arm ; to pursue 
the sedative system by a full dose of opium, — and there is none so good 
in the vast majority of cases, where patients tolerate it, — or of some 
other sedative agent ; and if, in the course of three or four hours, the 
mischief, for which the blood-letting was practised, be not subdued, to 
repeat it. 

The interesting fact was pointed out by Dr. Marshall Hall, that in 
inflammatory diseases, a much larger amount of blood may be drawn 
without inducing syncope that can be done in health, or in other 
diseases. The following table is the result of that observer's investiga- 
tions in regard to the tolerance of blood-letting in different maladies. 
The numbers represent the mean quantity of blood which flows before 
incipient syncope in the sitting or erect attitude. 



I. AUGMENTED TOLERANCE. 

Congestion of the brain 
Inflammation of serous membranes 
Inflammation of synovial membranes 
Inflammation of fibrous membranes 
Inflammation of the parenchyma of or- 
gans (brain, lung, liver, mamma, &c.) 
Inflammation of skin and mucous mem- 
branes (erysipelas, bronchitis, dysen- 
tery, &c.) . 



;xl— 1. 
;xxx — xl. 

jjxxx. 

i xv J- 



II. HEALTHY TOLERANCE. 



This depends on the age, sex, strength, " 
&c, and on the degree of thickness 
of the parietes of the heart, and is 
about ...... 



;xv. 



III. DIMINISHED TOLERANCE. 

Fevers and Eruptive Fevers . 
Delirium tremens and Puerperal Delirium 
Laceration or concussion of the brain 
Accidents before the establishment of in 

flammation .... 
Intestinal irritation 
Dyspepsia, Chlorosis 
Cholera 






Ixij — 3xiv. 
§x— xij. 

§viij— x. 

^viij. 
1 V J- 



164 SEDATIVES. 

The explanation of the increased tolerance of blood in inflammation, 
Dr. C. J. B. Williams apprehends, is to be found in the increased excita- 
bility of the heart, and tonicity of the arteries, which maintain a 
sufficient force and tension to preserve the circulation, especially through 
the brain, even when much blood is lost. " In asthenic or atonic dis- 
eases, on the other hand, the arteries being lax, and ill-fitted to transmit 
the blood, a smaller loss is felt, and syncope may result. The variations 
between inflammations occupying different seats must be referred to 
the arterial tone being less augmented in some than in others, and are 
therefore indications of the more or less sthenic character of the inflam- 
mation. The quantity of blood in the whole system will affect the 
heart's action, and arterial tension in a similar way ; and no doubt the 
more stimulating quality of the blood may contribute to the same 

results." 

The extent to which blood-letting should be carried, in cases of vio- 
lent internal inflammation, is often a matter of great difficulty with the 
discriminating, but ot none whatever with the reckless and uninformed. 
In his state of blissful ignorance, the latter continues to bleed ; and con- 
soles himself, when the fatal result has been hastened— perhaps mainly 
induced— by his agency, that the sufferer has fallen a victim to an in- 
curable malady. 

Many have laid down a rule, before referred to, that when blood- 
letting has been carried to such an extent, and so often, that we are in 
doubt whether it should be repeated, the decision should be in the 
affirmative. But with the disposition, which prevails so generally,— 
and which prevailed, a few years ago, to a much greater extent than it 
does even at present, — to bleed without due consideration, such a doubt 
will rarely be felt, without good ground at the same time existing for 
staying the hand ; and, therefore, the decision, according to the author's 
experience, ought generally, as before said, to be in the negative. The 
argument, commonly urged for the further abstraction of blood, is, that 
the inflammation manifestly persists, and that it must inevitably destroy 
if it be not arrested ; — that blood-letting is more likely to subdue it than 
any other therapeutical agent ; and that, if it should not, the physician 
will have the consolation of knowing, that he has done everything in his 
power to avert the melancholy termination. Were the abstraction of 
blood in all cases, and to any extent, devoid of danger, this mode of 
viewing the subject might be logical ; but mischiefs result in these and 
similar cases, which are fairly referable to it; and are equally serious in 
their results with the disease for which it may have been employed. 
Often, too, whilst the practitioner is taking away blood, he allows the 
patient to drink freely of water or other fluid, and, under the augmented 
absorbent agency induced by the diminution of the quantity of blood in 
the vessels, a state of anaemia or oligsemia supervenes ; and the blood 
is rendered so thin, that if the disease, for which repeated blood-letting 
was adopted, be hemorrhagic, and the hemorrhage be owing to transu- 
dation through the parietes of the vessels— as is almost universally the 
case — the recurrence of the hemorrhage is greatly facilitated. In an 
early part of this volume, the author has referred to an interesting case 
of anaemia, produced by excessive bleeding in what was supposed to be 



BLOOD-LETTING. 165 

periodical encephalitis ; and to the mischiefs so manifestly referable to 
an inadequate quantity of blood circulating in the vessels, as well as to 
the impoverished condition of that fluid ; and, to a minor extent, similar 
evils are often found to result from the same causes, although they are 
too frequently not appreciated, or, if appreciated, regarded as inevita- 
ble. Whenever anaemia of the kind referred to exists, the excitability 
of the nervous system is irregularly developed ; hyperaemic affections 
are apt to arise in various parts, which seem formidable, and yet require 
a very different mode of management from such as are met with in 
those who are plethoric, or whose blood is rich in fibrin and red cor- 
puscles. 

It must be borne in mind, too, that the researches of MM. Andral 
and Gavarret have established the fact, that the chief effect of loss or 
blood is to diminish the ratio of the corpuscles to the fibrin, — a state- 
ment, which the researches of MM. Simon, Becquerel and Rodier, and 
others have confirmed. As blood is abstracted, the fluid becomes im- 
poverished, and more watery; whence the density of defibrinated blood 
diminishes notably. The albumen also decreases ; but usually only 
slightly ; hence the diminution in the density of the serum is small. 
The fibrin is uninfluenced by venesection ; the extractive matters and 
free salts are unaltered ; the fatty matters are slightly lessened ; the 
serolin, always variable in quantity, is decidedly increased in some 
cases; the cholesterin appears to be but slightly increased ; the chloride 
of sodium and other salts remain unchanged ; and the iron is diminished 
slightly in the same proportion with the corpuscles. It would appear, 
therefore, that blood-letting influences but little the main morbid con- 
dition of the blood in inflammation, — the increase in the ratio of fibrin 
to red corpuscles. Its beneficial effect must consist in reducing the 
density of the fluid, and, therefore, facilitating its circulation through 
the obstructed or hyperaemic vessels. 

It was a remark of the distinguished Laennec, that the strength of 
the pulsation of the heart under the stethoscope is an excellent guide 
for the use of the lancet. "In all cases," he says, "in which the pul- 
sations of the heart are proportionately more energetic than those of 
the arteries, we may bleed fearlessly ; and be certain of an improvement 
in the state of the pulse. But if the heart and the pulse be alike feeble, 
blood-letting will almost always precipitate the patient into a state of 
complete prostration;" — and he adds: — "the certainty and facility 
with which the stethoscope affords or excludes the indications for 
blood-letting appears one of the greatest advantages conferred by this 
instrument." This is doubtless a good general rule ; but account must 
be taken of exceptions in nervous and hysterical subjects, in whom pal- 
pitations may exist, and a temporary increase of force be detected under 
the instrument. It must be recollected, too, that in certain serious 
maladies, as enteritis, the pulse may be slow and feeble ; whilst in 
inflammatory affections of infinitely less moment — as amygdalitis, — it 
maybe strong and bounding; and again, as previously remarked, in 
reaction from positive exhaustion, as after loss of blood, the excited 
state of the heart and arteries may deceive at first the experienced 
practitioner. 



166 SEDATIVES. 

Mere quickness or pulse, taken singly, can never be regarded as a 
positive indication for the use of the lancet, inasmuch as it occurs in 
diseases which are highly neuropathic, especially where they are ac- 
companied at the same time by debility ; and it is almost always pre- 
sent in approaching dissolution. The practitioner, consequently, who 
expects, under such circumstances, to diminish the velocity of the 
circulation by blood-letting, will find himself mistaken. In scarla- 
tina, quickness of pulse is one of the most marked functional phenomena, 
and in the most malignant cases this quickness is often most striking; 
yet blood-letting can rarely be employed in such cases ; and if it were, 
it would generally be found, that the quickness of pulse would be in- 
creased rather than diminished by it. 

Formerly — not many years ago, indeed — it was laid down, by many, 
as a rule of guidance, that in a case of internal inflammation, blood- 
letting ought to be repeated so long as the blood drawn exhibits a buffy 
coat; but this is a rule now properly abandoned. It is clear, indeed, 
from the results of observation, that, in some cases, it would exhibit 
this character immediately before the occurrence of fatal syncope. But 
the buff* is not perceptible in cases of high internal inflammation only; 
it is met with in acute rheumatism, in the pregnant condition, in chlo- 
rosis, and, at times, in persons of great nervous excitability. In the 
first of these cases, there is no disorganizing inflammation present- 
none, that requires the same activity of treatment to preserve life, which 
pleurisy, for example, does; and, in the second, the buff appears, when 
the female is in health. (Vol. i. p. 49.) Perhaps, however, the most 
important of the facts to be borne in remembrance is the third — that 
we observe it in the blood of persons of high nervous excitability, even 
when no inflammatory condition is present; and when, on the contrary, 
the blood is watery, — or does not contain the healthy proportion of 
solid constituents. Such cases give rise to great hesitancy and diffi- 
culty in the mind of the practitioner, when signs of hypersemia exist in 
an internal organ. The author attended a case of the kind, in company 
with Dr. Gibson, of Baltimore. The subject was an amiable and gifted 
young lady, whose temperament might be regarded as eminently ner- 
vous or impressible. She had been labouring under pain on breathing; 
but without much cough : the skin was, at the same time, hotter than 
natural, — decidedly so at some periods of the twenty-four hours ; and 
the mucous membrane of the tongue, although moist, was coated, and 
indicated the existence of internal hyperasmia. She had been judici- 
ously treated : blood had been taken ; and counter-irritation established, 
both on the region of the chest and in the secretory system in general; 
for the mouth had been slightly affected by mercury. A day or two 
before the author saw her, she had expectorated, in the morning, blood, 
which was florid, but not frothy, and was not brought up by any effort 
of coughing. At his first visit with Dr. Gibson, it was proposed that 
blood should be drawn, not so much in consequence of the presence of 
urgent symptoms, but from the apprehension, that the affection, which 
appeared to exist mainly in the pleura costalis, might extend ; whilst, 
at the same time, a knowledge of her temperament, and the character 
of her symptoms, suggested, that the abstraction should be practised 



BLOOD-LETTING. 



167 



with caution. The blood, previously drawn, was buffed ; and this was 
regarded as one element in the decision that a farther abstraction should 
be made. She was accordingly bled ; the blood was again buffed ; but 
the crassamentum was small in quantity, and very thin ; so that it could 
be laid hold of, and separated from the large amount of serum in which 
it was placed, and be held up like a piece of leather. Only a small 
quantity of blood was taken; and yet the depression produced by it 
was urgent, and sufficiently demonstrated the propriety of the great 
caution that had been exercised in the employment of the lancet. The 
pain was, however, entirely relieved ; and, by keeping up a centre of 
irritation, by means of the ointment of tartrate of antimony and potassa 
applied on the exterior of the chest, the symptoms w T ere entirely re- 
moved. For this fortunate termination she was mainly indebted to the 
discrimination of her attending physician ; for had he carried the blood- 
letting farther, prostration would have ensued to a much greater extent; 
a corresponding reaction would have been established, and any hypere- 
mia that might have existed would probably have been increased ; yet, 
if the buffy coat of the blood were to be regarded, in all cases, as une- 
quivocal evidence that a farther abstraction of that fluid should be 
made, it ought assuredly to have been practised in this case. In the 
case, too, of affection of the encephalon, which the author described 
as having attended with Professor Smith, (p. 154,) the blood exhibited 
the buffy coat; yet its abstraction, even in small quantity, induced 
violent palpitation and other nervous phenomena that prevented its 
repetition. 

It may be affirmed, then, as a rule, that the appearance of the buffy 
coat cannot, when taken singly, be esteemed a sufficient reason for the 
farther abstraction of blood ; that the propriety of a repetition must de- 
pend upon other symptoms taken along with the buffy coat ; and farther, 
that such a coat may be present, when there is no concomitant inflam- 
matory condition, or when it is by no means to a dangerous extent. 

The general views that have been laid down with regard to the use 
of blood-letting, will have demonstrated the value of this therapeutical 
agent in inflammatory affections ; and the circumstances that must be 
taken into consideration in judging of the extent to which the abstrac- 
tion of blood must be carried, and of the best mode of after manage- 
ment for reaping full advantage from it, where it may have been employed 
as far as the practitioner has deemed prudent, and yet where hypersemia 
may still exist. Such cases require the nicest discrimination ; yet blood- 
letting has been so much the fashion in all diseases of an inflammatory 
character, and — it may be said — in all sudden diseases, that the public 
voice calls loudly for the lancet ; and the practitioner, led away by 
popular clamour, and not sufficiently fortified by the possession of sound 
pathological and therapeutical principles, falls in too frequently with the 
wishes of bystanders, who are commonly totally ignorant of the proper 
course to be pursued. If, too, he be not possessed of right presence 
of mind, he may adopt measures of which his better judgment may by 
no means approve. 

On a public occasion some years ago, in an address delivered to the 
Graduates in Medicine at the annual commencement of the University 



168 SEDATIVES. 

of Maryland, the author had an opportunity of adverting to some cases 
of this kind, that are of daily occurrence. A man falls from a height, 
bruised— stunned perhaps — and the general call is for a surgeon to bleed 
him ; yet, in many of such accidents, a shock is given to the great 
nervous centres — the brain and spinal marrow — the effects of which 
bleeding is well calculated to augment — and augment fatally — if em- 
ployed immediately after the receipt of the injury, and before reaction 
has taken place. In like manner, if a person, when vehemently address- 
ing an auditory, falls down suddenly deprived of animation, the im- 
pression immediately is, that he has had an apoplectic seizure. A vein 
in the arm or neck, or the temporal artery, is immediately opened, and 
the state of suspended animation may thus be converted into one of 
death. The heart, in such cases, has ceased to act, and the free ab- 
straction of blood from the general circulation may not be well adapted 
to restore it. 

"When a person is attacked with apoplexy, it rarely happens that he 
dies instantaneously. A train of phenomena, characterized by loss of 
sensation, volition, and mental and moral manifestation, succeeds for a 
time; and is the precursor of dissolution. Circulation and respiration, 
in the meanwhile, continue ; but, where the heart dies first, the circu- 
lation ceases ; respiration is no longer accomplished, and the state of 
suspended animation becomes converted, almost instantaneously, into 
positive death. This view has been confirmed by the cases of instan- 
taneous death, which the author has had an opportunity of examining. 
In most of them, the state of the heart has indicated, that the cessation 
of its action was the first link in the chain of phenomena. 

The satisfaction often felt at the exhibition of energy on the part of 
the practitioner is well exemplified by an anecdote, which an illustrious 
native of this country — now no more — who had filled the highest office 
in the gift of a free people, and whom the author had the honour of 
ranking amongst his personal friends — was in the habit of recounting. 
Travelling from Virginia towards the north, he rested for a night at a 
tavern on the road. Soon after his arrival, the hostess came in from a 
neighbouring house with the females of her family, — all exhibiting 
marks of deep distress. He was informed, that they had been witness- 
ing the parting scene of a young friend, who had died of some acute 
affection. " But, thank God !" observed the contented matron, "every 
thing was done for him that was possible, for he was bled seven-ancL 
twenty times." " It is not " — says the inimitable Moliere, who was un- 
sparing in his appropriate philippics against the profession, and the 
public of his day—" it is not, that, after all, your daughter may not 
die ; but, at all events, you will have done something, and you will 
have the consolation that she died according to form." 

After the lecture, to which allusion has been made, was delivered, 
the author's friend, Dr. Wright, of Baltimore, put into his hands a work 
published by him upwards of thirty years ago, which, in an appendix, 
contains views so strikingly like those which the author promulgated on 
that occasion, that they might be regarded as the prototypes of his. 
Dr. Wright's excellent ' sketch^ had not previously, however, fallen un- 
der his observation ; the coincidence of views is, therefore, accidental, 



BLOOD-LETTING. 



169 



and it afforded the author no little satisfaction to find, that his sentiments 
accorded so strikingly with those of so excellent an observer. The 
appendix contains a masterly critique on the views of Dr. Rush, as con- 
tained in his 'Defence of Blood-let ling .'— " 'We must do something,' is 
the most unfortunate and pernicious maxim," says Dr. Wright, " which 
has ever been introduced into the policy of medicine. At the moment, 
when it received the sanction of professional reputation, professional 
imposture was legalized, and ignorance and artifice acquired confidence 
from feeling security. I refer to no particular authority for the inculca- 
tion of this sentiment. It has unhappily been stamped with the appro- 
bation, and received the connivance of numbers, who could have 
wanted nothing but reflection to have refused it their assent. Its adop- 
tion has never wanted advocates ; it has been eagerly received, and 
amply exercised ; and the profession is to this day disgraced by the 
admission, that 'mankind must be amused.' Had half the pains been 
taken to acquire professional understanding, which have been practised* 
to impose on society, this maxim might long since have been commuted 
for the more honourable sentiment, that mankind must be instructed. 
It is under the covert of this professional mask, that the prejudices of 
the world have been pressed into the service of the practitioner, and its 
ignorance arrayed against its security. It is thus that a convenient re- 
source has been provided against that false shame, which dreads a 
candid avowal ; and the physician, armed with implements, for whose 
use or consequence he apprehends no responsibility. Among the wea- 
pons of this licensed warfare against decorum and integrity, the lancet 
holds a distinguished rank. Like the sword of Alexander, it is the 
universal solvent of every difficulty ; and has often been made to sever 
the gordian knot, which defective ingenuity was incompetent to unravel. 
Justice would be violated were those remarks pointed solely at the 
worthless herd, whose business is imposture; who openly repose their 
claims upon the hopes and fears, the follies and the weakness of their 
fellow creatures. They reach even him to whom contingent circum- 
stances have opened a more ample and elevated range in professional 
relation ; who, without an effort to improve that profession, is solici- 
tous to enjoy, by other means, the benefits of its exercise." 

The whole of Dr. Wright's remarks on the subject of blood-letting 
as a therapeutical agent are judicious; and it is a matter of regret, that, 
owing to the exhaustion of the copies, the work is not available to the 
profession. It is to be hoped, however, that he may find leisure to lay 
before it the substance of the appendix to which the authorhas referred, 
with the modifications — if any — that have been suggested by his sub- 
sequent observation and reflection. 

Allusion has more than once been made to the induction of syn- 
cope, as marking the effect produced by blood-letting on the functions; 
and this is the criterion established by many practitioners, as to the 
requisite quantity of blood to be abstracted in cases of internal inflam- 
mation. In general, no harm may arise from the rule, but there are 
exceptions to this, as well as to all other rules. Fortunately, the condi- 
tion of inflammation impresses a degree of tolerance on the system, 
which, in the vast majority of cases, enables it to withstand the abstrac- 



170 SEDATIVES. 

tion of blood, even when carried to an injudicious extent ; but in ex- 
treme ages — in early infancy, and in advanced life — the frame does not 
rally so readily from the sedation ; and the author is satisfied, from 
actual observation, that many persons at those ages have had their 
deaths hastened — if not mainly occasioned — by the too vigorous use of 
blood-letting. This is especially apt to occur in diseases, in which the 
degree of inflammatory irritation is not so great as to communicate to 
the system the full tolerance ; and especially in those cases of coma or 
convulsions in early childhood, to which reference was previously made, 
as being presumed to depend on "congestion " and, therefore, to re- 
quire blood-letting. In these unhappy cases, the fancied signs of con- 
gestion increase after the operation ; the farther abstraction of blood is, 
therefore, determined upon ; the powers of life fail ; effusion takes 
place into the ventricles, and the child dies from exhaustion,— that 
exhaustion having been partly induced by the means adopted for the 
removal of the malady. Such is not, however, in all probability, the 
opinion of the practitioner. He consoles himself with the reflection, 
that the fatal event has been occasioned by the intensity of the disease. 
When a similar state of affairs occurs, he has, consequently, recourse 
to the same management, with like results ; and, at the end of a long 
life, he is perhaps ready to exclaim, — that he has never had occasion to 
regret the employment of blood-letting, but has often reproached him- 
self for not having pushed it farther. 

All this has arisen from the indiscriminate faith, placed in this valua- 
ble agent — valuable only when appropriately employed — by others 
besides the Sangrado of Le Sage. " With regard to age," says Pro- 
fessor A. T. Thomson, — " in infancy, the laxity of the solids, and the 
relative proportion of the serum or watery part of the blood to the 
crassamentum or clot, which consists of fibrin, and colouring matter, 
are more considerable than in adult age : blood-letting, by increasing 
this greater proportion of serum, proves hurtful; and a state of syncope 
in infants is always one of great danger. The first effect of exhaus- 
tion in such young subjects is an increased degree of irritability, which 
leads to stupor, and generally terminates in convulsions; the pulse is 
quickened, the pupil of the eye dilates, and symptoms closely resem- 
bling those which precede the effusion of water in the ventricles present 
themselves. I have seen this more than once occur in children in 
whom symptoms resembling those of inflammation of the brain, accom- 
panying irritation of teething, have displayed themselves ; and leeching 
or cupping has been resorted to ; but, instead of affording relief, a state 
of evident defective stimulus supervened ; and, in one case, snoring, 
stertor, and other appearances of apoplexy having followed the bleed- 
ing, more leeches were applied, and the infant died. This state is 
detected readily by attention to the state of the breathing, which seems 
to be performed almost wholly by the diaphragm ; and is always accom- 
panied with the evolution of much flatus ; both circumstances denoting 
a very low state of the nervous energy. It is best obviated by white 
wine whey, opium and ammonia, administered warm, in small quantities, 
and frequently repeated. In youth, and in the vigorous and robust, on 
the contrary, reaction takes place, and is especially marked after re- 



BLOOD-LETTING. 



171 



peated venesections. The most favourable age for bearing blood-letting 
is from eighteen to forty-five. In old people the reaction is extremely 
feeble; and, during the flow of the blood, exhaustion often steals on so 
.insidiously and imperceptibly, that when nothing injurious is anticipated, 
syncope appears ; no reaction can be induced, or it is defective, and 
gives way to a state of positive sinking. The risk in such a case is 
extreme." 

The dangers conceived to arise from general blood-letting, in early 
childhood, are considered by some so great, that they never have re- 
course to it, preferring leeches or cupping ; but, provided it be carefully 
practised, it is safe, and the impression made upon the diseased condi- 
tion — if one of active inflammation — is usually more decidedly salutary. 
The abstraction should not, however, be carried so far as to induce 
syncope. Owing to one or more fatal events having succeeded to the 
operation in Edinburgh, the Professors, — during the author's attendance 
on the lectures there, — were in the habit of inculcating excessive caution 
in regard to its use at that early age. " The experience of fifteen years, 
and some of it of a sorrowful kind" — says Dr. Casper Morris, of Phila- 
delphia, " has convinced me fully, that children bear bleeding illy, and 
in asserting my convictions that as many children have sunk under the 
ill-judged use of depletion as from incurable disease, I would not cast 
censure upon others without taking to myself a full share of it." In his 
recent Cl Essays on Infant Therapeutics ," (New York, 1849), Professor 
J. B. Beck has urged great caution in the use of this agent in such 
cases ; first, on account of the young subject not bearing the loss of 
considerable quantities of blood as well as the adult; secondly, on ac- 
count of the nervous system being more powerfully affected by the loss 
of blood ; thirdly, on account of the repetition of blood-letting not being 
so well borne ; and fourthly ', because the effects of local blood-letting, 
especially leeching, on the child are different from what they are on the 
adult. In the latter, the effect of leeching is in a great measure local, 
and it is not usually resorted to, until after general blood-letting is con- 
sidered inadmissible. In a child, on the contrary, it produces very much 
the same effect as general blood-letting. 

Of the propriety of caution in advanced life, the author had a striking 
instance soon after he commenced practice. It was, indeed, of so alarm- 
ing a nature, that it could not easily be forgotten. An elderly gentle- 
man was directed to be bled for chronic bronchitis, and the author was 
requested to perform the operation. After the abstraction of a few 
ounces, syncope rapidly supervened ; and it was so long before the vital 
functions were restored, that he became seriously apprehensive the 
patient would die under his hands. He ultimately recovered ; but a 
considerable period elapsed in this stage of exanimation or transition 
between life and death. The same caution is requisite in taking away 
blood when there is chronic disease of the heart or great vessels. The 
author has known two cases, in which the syncope, induced by blood- 
letting practised for the removal of symptoms of internal hypersemia, 
became the syncope of death; the irritability of the heart seemed to be 
suddenly destroyed, and it never resumed its pulsations. In one of the 
cases, the existence of organic disease of the heart was known ; but the 



172 SEDATIVES. 

individual seemed as if he could tolerate a copious abstraction of blood ; 
before, however, a few ounces had been taken, he fell from his chair, 
and expired. In such doubtful cases, the patient should be placed in 
the horizontal posture, and the flow of blood be arrested, before any 
decided effect appears to be exerted upon the functions of innervation 
or circulation. 

Such are some of the main points to be borne in view in the employ- 
ment of general blood-letting as a therapeutical agent, in inflammatory 
affections especially. There are cases, however, in which our object is 
to bleed to positive syncope — to relaxation — and where we have no 
fears of reaction ; as where we are desirous of resolving forcible mus- 
cular contraction, or of reducing strangulated hernia. With this view, 
the patient is placed in a sitting posture, and the blood is made to flow 
from a free orifice in one or both arms. 

Again, there may be cases, — as already remarked, — in which gene- 
ral bleeding may be unadvisable ; and yet where topical bleeding may 
be advantageous. There was a time — indeed, the feeling still exists 
with a few — when it was maintained, that there can be no case in which 
topical blood-letting appears to be required, which could not be relieved, 
arid more effectually, by blood drawn from the general system ; and 
certain practitioners have gone so far as to express their regret, that 
such agents, as a leech, or a scarificator and cupping-glass were ever 
known. There is, here, probably, defective observation — modified, 
perhaps, by the existence of ancient and preconceived opinions — which 
interferes with the correct observation and reflection of the practitioner. 
The author has repeatedly satisfied himself, that local abstraction of 
blood has produced the most beneficial results, when general blood- 
letting had been — or would, to all appearance, have been — entirely in- 
effectual. In many of these cases, however, the beneficial result was 
probably not owing so much to the blood drawn, as to the attendant 
revulsion, — a modus operandi of blood-letting, general as well as topi- 
cal, which is considered elsewhere. (See Revellents.) 

It has been a common remark, that local blood-letting — when not 
used as a revellent, but simply with the view of diminishing the quan- 
tity of circulating fluid, and of acting, in this way, on the powers of the 
system — is inefficient, and cannot be relied on when internal inflamma- 
tion is present ; but this is an erroneous position. By multiplying the 
number of cups, or leeches, we can as certainly, although not always as 
effectually, reduce the organic actions, as by opening a vein ; but the 
blood flows more gradually, and is, consequently, adapted for cases 
where venesection might not be appropriate. Every practitioner, who 
has employed leeches freely, must have met with cases, in which the 
most decided effects were produced by the depletion, which they occa- 
sioned. Each good American leech, if we reckon the quantity of blood 
that may be encouraged to flow from the leech-bites, may be regarded 
as withdrawing a third of a fluidounce of blood ; and, consequently, if 
we apply as many leeches as some of the modern French practitioners 
were in the habit of prescribing in gastro-enteritic, and other inflamma- 
tory diseases, we may take away a larger quantity of fluid from the ves- 



BLOOD-LETTING. 173 

sels than we could do with impunity from the vein of the arm. Twenty 
or thirty ounces constitute a large bleeding ; and it will rarely happen 
that the lesser quantity can be taken from a vein without the superven- 
tion of syncope, and the inconveniences, which in particular habits, are 
apt to follow that state ; whilst a much larger quantity can be abstracted 
under the gradual flow that takes place either when leeches or cups are 
the agents. An experienced leecher of Baltimore informed the author, 
that there is not much difference in the quantity of blood, which the 
American, the Turkish, the German or the Spanish leech can contain. 
This may be estimated at about a quarter of a fluidounce ; but they 
differ essentially as respects the flow they occasion from the bites. By 
the Turkish and the German, a fluidounce may be lost, including the 
quantity swallowed by the leech; and by the Spanish, half an ounce ; 
whilst we can scarcely calculate on more than a third of an ounce from 
the American. 

It has fallen to the author's lot to witness some alarming cases of ex- 
haustion, especially in children, where leeches had been applied ; in 
two, indeed, the result was fatal. In both, due attention had not been 
paid, and a large amount of blood was lost before the cause of the sink- 
ing was discovered ; and in one, every attempt to arrest the flow of 
blood failed. These cases are rare ; but they constitute objections to 
the use of leeches, which do not apply to cupping, — the flow from the 
wounds made by the scarificator being more readily arrested. When 
practicable, the leeches should be placed over bone, in order that pres- 
sure may be conveniently made on the bleeding vessels, should such a 
course be requisite. " From the greater vascularity of the skin" — says 
Dr. J. B. Beck — " the amount of blood lost by a leech, applied to a 
young subject, is much greater than in the adult, and it is frequently 
much more difficult to arrest the hemorrhage from it. The general 
effect, then, of leeching on the young subject, is much greater than 
upon the adult. Hence it is, that cases are so frequently" [?] lt occur- 
ring in which children die from leeching. Of this we have numerous 
cases on record." 

" When leeches are applied to soft parts," — says Dr. A. T. Thom- 
son — " for instance, to the abdomen, it is truly astonishing how much 
blood sometimes is detracted ; particularly when a poultice is applied 
over the bites, and the patient is kept warm in bed : to prevent, there- 
fore, injurious symptoms of exhaustion from such a circumstance, the 
poultice should be frequently examined. This i» more likely to occur 
in children than in adults ; and in children it not unfrequently happens 
that the bleeding cannot be stopped without encircling the orifice of the 
ligature. On this account leeches should never be applied late at night 
on children; for, as the application of leeches in infancy must be re- 
garded as a species of general blood-letting, the precise number which 
will regulate not only the quantity, but be equivalent to rapidity in the 
detraction of the blood should be determined ; but the bites should be 
instantly closed, on observing that the system is brought under the in- 
fluence of loss of blood." 

In all cases of hyperaemia, occurring in the child, or in the adult, the 



174 SEDATIVES. 

therapeutist will have to exercise the best of his judgment as to the 
propriety of the adoption of general or local blood-letting, or both. 

It is not a true position, then, that general can always be substituted 
for local blood-letting with equal advantage ; — nor does the converse of 
the proposition hold good. Both general and local blood-letting diminish 
the quantity of fluid circulating in the vessels ; they are both, therefore, 
adapted for cases of polysemia or plethora, although the former is more 
available than the latter where copious abstraction of fluid is necessary; 
but general blood-letting is not adapted to every case of hyperemia. 
In some cases, a small quantity of blood, obtained from the inflamed 
part itself, affords instantaneous relief, when general bleeding has been 
used in vain ; and there are cases, again — as has been shown, when 
treating of Excitants — that are relieved by stimulating the vessels to 
contraction, after both local and general blood-letting have failed. 

It must be borne in recollection, that inflammation is not caused 
directly by the condition of the general circulation, but by a morbid 
state of the capillary vessels of a part. Inflammation may attack the 
arteries and veins themselves; and even this is not, or need not be, 
connected with the state of the blood in the inflamed vessels, but is de- 
pendent upon a morbid condition of the nerves and vessels that supply 
their coats. Blood-letting, consequently, even in this case, can be but 
an indirect agent. By diminishing the amount of circulating fluid, it 
may reduce the activity of the capillary vessels, and thus remove the 
hypersemia ; but it exerts no direct sedative agency on the vessels them- 
selves. Such is the fact in every case of inflammation. The action of 
Ihe capillaries is distinct from that of the heart; and — as before re- 
marked — inasmuch as inflammation is produced by a morbid condition 
of the capillaries, the most philosophical plan of medication would be, 
to direct our remedial agents to those vessels ; but as this cannot 
always be effected, we are compelled to have recourse to the only suc- 
cedaneurn we possess — the abstraction of blood from the general sys- 
tem, and the sedation which this is capable of effecting. 

In diseases of certain parts of the organism, we have a choice of ves- 
sels so as to enable us at times to empty the affected capillaries, or to 
reduce the quantity of blood, or, in other words, the amount of stimu- 
lus in them, more effectually ; but our sphere of action, in these cases, 
is extremely limited ; and perhaps in internal inflammation null. It 
can be understood, that if hyperaemia were present in the hand,— 
blood, taken from theubend of the corresponding arm, would empty the 
vessels concerned more freely than if it were taken from the other arm, 
or from the external jugular ; but in hyperemia of an internal organ, 
we have no mode of opening a vein passing between the inflamed part 
and the heart. It has, indeed, been recommended, under the views 
here laid down, that blood should be taken, either from the temporal 
artery, or from the external jugular vein, in cases of inflammatory affec- 
tions of the encephalon ; yet slight reflection will show, that no signal 
advantage can be expected from this course ; and, indeed, plausible 
arguments might be advanced to prove, that the disadvantages might 
overbalance the presumed benefits. For example, blood, in every case 
of the kind, where the artery is opened, must come from the external 



LOCAL BLOOD-LETTING. 



175 



carotid — a vessel which does not supply the encephalon — and, conse- 
quently, it cannot be supposed, that any benefit could accrue from 
selecting that vessel in a case of encephalitis. It may be argued, 
however, that if more blood be solicited into the temporal artery, less 
will pass along the internal carotid ; but this argument, again, might be 
combated — and philosophically — under the view, that as both the inter- 
nal and external carotids arise from one trunk, any cause, that would 
solicit blood into the one, might attract a larger afflux along the common 
trunk ; and, therefore, augment the flow into the other. 

The same reasoning applies to phlebotomy practised upon the exter- 
nal jugular vein in head diseases. If we could open the internal jugu- 
lar, we might assuredly materially affect the state of the encephalic 
vessels, by emptying the sinuses, which, by their union, constitute that 
vessel, or rather supply it with blood ; but this is impracticable ; and, 
as the external jugular conveys the blood back to the subclavian from 
the exterior of the head only, no advantage can accrue from selecting 
it, where the encephalon is in a morbid condition. 

It has been proposed by many, that a branch of the temporal artery 
should be opened in cases of violent ophthalmia ; but the proposition 
has probably been hazarded without due examination. If we could 
always take blood from the ramifications that proceed towards the eye; 
and, after the blood-letting, destroy them, by cutting them across, the 
plan might be advantageous ; but unless we divide those very branches, 
the effect may be anything but salutary. By obliterating some of the 
arterial ramifications, more blood may be distributed to the others; and, 
in this way the ophthalmic branches may become developed, and more 
mischief than good accrue from the operation. Owing to these objec- 
tions, arteriotomy is not often had recourse to in such cases : it is rarely, 
indeed, employed, except in sudden seizures, as of apoplexy ; and then 
rather on account of the ease with which it can be accomplished — in 
the absence of bandages, &c, — than in consequence of any therapeuti- 
cal preference, which should be given to this mode of abstracting blood. 
It is an important fact, moreover, connected with this inquiry, that the 
experiments of M. Poiseuille with his hsemadynamometer have shown 
conclusively, that the pressure of the blood in the different vessels is 
alike, and consequently, that the tension can be relieved as effectually 
by taking blood from one vessel as from another. 

The essential difference, after all, between topical and general blood- 
letting, is, that by the one we abstract blood from the capillaries ; by 
the other, from the larger vessels. Now, in internal inflammation, topi- 
cal blood-letting cannot be employed on the vessels of the part : it 
must be effected at a distance from the seat of the mischief; and, ac- 
cordingly, its operation is of a mixed character — combining depletion 
and revulsion; but in external inflammation, we can make our deple- 
ting agents affect the vessels themselves, that are morbidly implicated. 
With this intent, cupping is rarely used. The operation cannot well 
be borne on an inflamed surface, owing to the pressure of the cups. 
Scarifying the part is, however,— in diffusive inflammation especially,— 
a most energetic agent ; and half an ounce of blood, discharged from 
the over distended vessels, is followed by more benefit than all other 



176 SEDATIVES. 

remedies together. Mr. Lawrence has well shown the marked utility 
of free scarifications through the integuments in the diffusive inflamma- 
tion of the skin, which constitutes erysipelatous inflammation ; and in 
the varieties of erythematous inflammation of the fauces, which are 
attended by deep dusky redness, and very painful deglutition, without 
any great degree of swelling of the mucous membrane of the fauces or 
of the subjacent parts, signal relief is afforded by deeply scarifying the 
membrane. The pain on deglutition is often almost instantaneously 
removed ; and the cure is rapid. In all such cases, the scarification 
should be free. The blood generally flows readily from the divided 
vessels ; retraction of their extremities takes place ; and a new recu- 
perative action is substituted for the more sluggish and asthenic that 
constituted the original affection. Similar good effects supervene on 
scarification of the tunica conjunctiva in inflammation of that mem- 
brane. 

Blood is sometimes abstracted from the capillaries of an inflamed 
part by means of leeches ; but it has been made a question with the 
reflecting, whether leeches are not likely to occasion more mischief 
than benefit, owing to the irritation excited by their bites, and the 
afflux of blood to the part caused by their sucking. Apprehensive 
that such may be the consequence, many therapeutists are in the habit 
of applying them on the sound parts in the vicinity of the seat of inflam- 
mation ; but here, again, it may be a question whether there may not be 
evils attending the practice that are weighty. 

When leeches are applied over an inflamed surface, they obtain the 
blood immediately from the affected capillaries. This, of itself, ought 
to be salutary. But it is asserted, that their bites become centres of 
irritation, and that they may augment the phlogosis. This may be the 
case ; but in the generality of instances the new action, thus excited, 
has perhaps an opposite effect ;— accompanying, as it does, the evacua- 
tion of the dilated capillaries, it may increase their tone ; prevent sub- 
sequent distention ; and thus remove the hyperaemia. When, however, 
leeches are applied near the inflamed part, they cannot empty the 
affected capillaries; and by attracting blood into the neighbouring ves- 
sels, they may occasion a greater afflux towards those morbidly impli- 
cated. The author is not in the habit of applying leeches immediately 
on the part in external inflammation ; but where he has done so, they 
have not seemed to him to be followed by the aggravation of symp- 
toms anticipated by some ; and in many cases marked relief has been 
experienced. W r here applied at all, it appears to him, that they should 
be placed over the inflamed vessels rather than in the vicinity. 

The conflicting views, above mentioned, have been, and are, fre- 
quently entertained in cases of mastitis occurring after delivery. Whilst 
some recommend general blood-letting, and revulsion effected by power- 
ful emetics and cathartics ; others advise the application of leeches ; and 
others, again, are of opinion, that their employment is not productive of 
any advantage. The author has used them in such cases more than 
once ; and it has appeared to him with benefit ; but he has seen more 
from the employment of agents of the excitant kind. The loose texture 
of the mammae allows the capillary vessels to be readily over-distended ; 



LOCAL BLOOD-LETTING. 



177 



an asthenic condition is thus induced in them, which is the source of 
excitation in the arterial ramifications continuous with the asthenic 
capillaries, and this asthenic condition is best removed by the applica- 
tion of excitants — as of heat considerably greater than that of the body 
— to the inflamed part. 

Where we are desirous of obtaining a larger quantity of blood than 
would flow spontaneously from leech-bites, even when encouraged by the 
application of cloths wrung out of warm water, or by that of a warm 
cataplasm, cups are sometimes placed over the bites. A considerable 
quantity of blood may be thus abstracted ; and we have the advantage 
of the revulsion, which the cupping-glass is capable of effecting, should 
the propriety of such revulsion be indicated. 

It has long been the custom at the commencement of the cold stage 
of intermittents to apply ligatures to the extremities ; which, in many 
cases, have given occasion to a mild hot stage, and abridged the dura- 
tion of the whole paroxysm. Their modus operandi has been a matter 
of question. By some, it has been supposed, that the obstruction to 
the venous circulation in the extremities causes an accumulation of 
blood in the superficial veins ; and a consequent increase in the action 
of the heart. The true explanation is probably the one suggested by 
Dr. Mackintosh : — the detention of blood in the superficial vessels cuts 
off", as it were, a certain quantity of fluid from the circulation, so long 
as the detention continues ; and in this manner exerts an analogous 
effect to the withdrawal of the same quantity of fluid from the vessels. 
This is illustrated by the following case, cited by Sir George Lefevre 
from Dr. Wilson, in which the disposition to swooning in an erect alti- 
tude appeared to be owing to varicose veins of the lower extremities 
robbing the brain of its usual quantity of blood. A lady, past the middle 
age, was so subject to faint when in the erect posture, that, although 
otherwise in good health, she was confined to her bed and sofa. As 
soon as she attempted to rise, she felt faint or even swooned. The 
cause of this phenomenon for a long time baffled the skill of her 
medical attendant, until, by some accident, he discovered that she had 
immense varicose veins in both legs ; and in the erect posture these 
became reservoirs for the blood, which accumulated too much in them 
to be propelled forward ; hence, the balance of the circulation was de- 
ranged ; and the brain, robbed of its usual quantity of blood, manifested 
symptoms of weakness. By the application of proper bandages, which 
supported the vessels when she was in the erect posture, the distress- 
ing affection was overcome. 

HiEMosTAsis — as this mode of arresting the blood in the vessels has 
been termed — has been strongly recommended by Dr. Thomas Buckler 
of Baltimore, as a sedative agent, especially in internal hyperemia or 
inflammation ; and there can be no doubt that it may be extensively 
available. "It is capable," he remarks, "of exerting, under given 
conditions, a more powerful control over the circulation than the lancet, 
antimony, or digitalis, and controls the heart's action without exhaust- 
ing the vital forces, or giving rise to the ill consequences, which the 
protracted use of most of the sedative agents is likely to do ; and, 
Vol. II.— 12 * 6 J 



178 SEDATIVES. 

finally, haemostasis in the hands of judicious practitioners must prove 
the means of saving an incalculable amount of blood ; to say nothing of 
the incredible benefits, which would be derived from its adoption by 
those Sangrados of our art, who bleed empirically in all conditions, 
and who, in many cases, like the fabled vampire, suck the living cur- 
rent until the vital powers are spent." 

H^mospasia, described under Revellents, acts sedatively in a 
similar manner to haemostasis. 



Under the head of sedatives may be included a set of therapeutical 
agents, now much used, in Italy more especially ; but also adopted in 
France and in Great Britain, — rarely in this country, — which, by remo- 
ving excitation, might be termed sedatives, but by their propounders, 
have been called contrast imulanis ; and the theory which suggests 
them, the theory of contra-stimuluSj—fthe new medical doctrine of Italy, 
- — La nuova Dottrina, &c. 

Prior to the termination of the last century, the doctrines of Brown 
were universally embraced in Italy ; and they continued in vogue until 
Kasori, on the occasion of a petechial fever making its appearance in 
Genoa, subjected the prevalent views to considerable modification; 
and, as in most similar cases, ended by embracing others diametrically 
opposite. Rasori maintained, that most diseases are owing either to an 
augmentation of excitability, or to an excess of stimulus ; and he con- 
ceived, that there are certain medicinal agents, which possess a pecu- 
liar debilitant power ; and which act upon the excitability of the frame 
in a manner directly opposed to that in which stimulus acts upon it. 
To this power he gave the name contra- stimulus. 

The mode in which the different contra-stimulants have acquired 
their reputation appears to have been as simple as it must frequently 
have been fallacious. Every agent, which succeeded in removing a 
sthenic disease, could do so only, it was presumed, by diminishing the 
excitability, or removing the stimulus: accordingly, it was a contra- 
stimulant. Substances were therefore classed together, which bore no 
relation to each other — as regarded the physiological phenomena they 
induced — either in their immediate properties, or in their secondary 
effects. In the lists are to be found emollients — as milk and gum; 
astringents— -as acetate of lead ; tonics— as gentian, simarouba, iron, 
and, according to some, even cinchona ; excitants— as turpentine, 
squill, and arnica ; emetics — as tartrate of antimony and potassa, and 
ipecacuanha; narcotics — as stramonium and belladonna; acrid poi- 
sons — as arsenic, nux vomica, cantharides ; and a host of other animal, 
vegetable, and mineral substances, which have no kind of analogy to 
each other. It has been properly observed, that this manner of regard- 
ing the effects of medicines tends essentially to bring together the most 
dissimilar substances, as well as to separate such as are closely allied ; 
and, consequently, to confound all. 

It may be said of this theory, however, as of every other, that the 
practice built upon it has added valuable facts to therapeutics ; and 
not the least of these is the knowledge, that tartrate of antimony and 



CONTRA- STIMULANTS. 179 

potassa may be administered in large doses, in inflammatory affections, 
not only with impunity, but with advantage. This potent emetic may 
be given to the extent of ten or twenty grains or more, in divided 
doses, during the day, without either producing vomiting or purging; 
or, if the first doses prove emetic, a tolerance may be soon acquired ; 
and the subsequent doses be followed by no manifest effect, except the 
diminution of the febrile symptoms. At other times, the urinary and 
cutaneous depurations appear to be largely augmented, and rapid ema- 
ciation succeeds to its administration. The contra-stimulant physicians 
maintain, that the exaltation of the vital manifestations, in febrile and 
inflammatory diseases, enables the system to bear the large doses of 
this and other contra-stimulants ; and they say, that the tolerance van- 
ishes with the disorder that communicated it ; but this assertion is not 
confirmed by experience. There is, certainly, a greater resistance to 
the action of these agents, as there is to blood-letting, when all is exalt- 
ation ; but the power of resistance does not cease, although it is dimi- 
nished, when the exaltation ceases. Some individuals, too, never 
possess the necessary tolerance ; so that, with them, tartrate of anti- 
mony and potassa does not produce contra-stimulant effects; and it 
would seem, that there are, also, what the French term " medical con- 
stitutions," or " epidemic conditions," which forbid its employment. 
Thus, according to M. Bricheteau, although it was so successfully 
used in 1831, it could not be beneficially administered at the end of 
1832, and the beginning of 1833. Not until the autumn of the last 
year could it be resumed advantageously. On one occasion it was 
given in the hospital by an Eleve de garde, during the choleric epidemy. 
The most violent symptoms supervened, and the patient died of cholera 
morbus, no sign of which existed before the tartrate was taken. 

Of the different phlegmasia, acute rheumatism and pneumonia are 
those that are considered to have been most successfully combated by 
this agent in a large dose. « Emetic tartar," says M. Bricheteau, 
" should generally be preceded by blood-letting ; and commonly it is 
advisable not to have recourse to the former unless the latter is insuffi- 
cient, except in cases in which blood-letting is contra-indicated, or im- 
possible, owing to some special circumstances,— as happened to me 
once in the case of a rickety individual, who had no veins adapted for 
phlebotomy. The medical constitution of the season, is, also, occa- 
sionally opposed to the abstraction of blood : in such cases, tartrate of 
antimony and potassa is a valuable agent. Recourse may, likewise be 
had unhesitatingly to it at the very first, when the patient is exhausted 
by age or other causes, and appears to be too weak to bear the abstrac- 
tion of blood ; or, where a positive refusal is given to the proposition 
for phlebotomy." « This agent," he adds, « must also be of great 
advantage, and of convenient employment, in country situations, where 
the physician can rarely pay his visits at an early period. It may be 
practicable, by this method, and with the aid of an intelligent person, 
to regulate the treatment of a case of pneumonia or of rheumatism for 
several days after having premised a copious abstraction of blood, if it 
be considered desirable." The fact, however, referred to by M. Briche- 
teau— that it is not every one who presents the necessary tolerance— 



180 SEDATIVES. 

would render this agent by no means as easy of application by the laity 
as he presumes. 

Granting — and it would seem it must be granted — that tartrate of 
antimony and potassa is a sedative agent, it becomes interesting to 
inquire into the mode in which such agency is exerted. It is, as is 
well known, one of our best suppurants, when we are desirous of estab- 
lishing a centre of fluxion on a part of the cutaneous surface, with the 
view of removing an internal disease. Experience, too, has sufficiently 
shown, that, when given in large doses, it produces pustulation in the 
mouth and fauces, if not lower down the alimentary tube. In a case 
which occurred under the author's care in the Baltimore Infirmary, this 
effect of the antimonial was strikingly evidenced. M. Bricheteau — who 
has administered it largely, as a contra-stimulant — says its local action 
is exerted more particularly on the mouth, tongue, and pharynx, where 
false membranes and pustules are occasioned by it; but these lesions, 
he thinks, are by no means common. The oesophagus, he says, never 
participates ; and they are more frequent in the intestinal canal than in 
the stomach ; and, in the former, the lower part of the small intestines, 
and the commencement of the large, exhibit themselves more sensible 
to the action of the antimony than other portions of the tube ; but it 
cannot be said, that sufficient opportunities have occurred for testing 
the effects of the remedy, and for separating the morbid appearances 
which have presented themselves, and which may have proceeded from 
other causes. He is of opinion, that the lesions, which may be referred, 
with the greatest probability, to the use of tartrate of antimony and po- 
tassa, — although he admits they are frequently owing to other inappre- 
ciable causes, — are, injection or infiltration of the submucous tissue of 
the intestines, and softening of the mucous membrane. In the mouth, 
considerable inflammation — either pustular or ulcerous — is sometimes 
observed, which speedily disappears after the discontinuance of the an- 
timony. 

Many facts and arguments tend to the conclusion, that the contra- 
stimulant virtues of tartrate of antimony and potassa may be dependent 
upon its revulsive properties ; that this revulsion is produced in the 
lining membrane of the alimentary canal ; and that when it is accom- 
plished, the excited actions, going on elsewhere, become diminished, 
and more or less nervous and vascular concentration takes place towards 
the seat of the artificial revulsion, whilst the general effect is one of 
sedation. Rasori thought, that the remedy lessens stimulation, or aug- 
mented excitability, directly: Laennec first maintained, that it acts as a 
revellent by irritating the stomach ; but the followers of Broussais hav- 
ing made this a ground of opposition to the remedy, he latterly main- 
tained, that it invigorates the activity of the absorbents; whilst Dr. C. 
J. B. Williams suggests, that the most reasonable view to take of its 
operation is, that it acts chiefly by diminishing the tonicity of the vas- 
cular system. He considers, in other words, that antimony — and some 
other remedies— " reduce directly the tone of the vascular fibre, 
acting as relaxants." ''Small doses," he adds, "certainly relax the 
pulse and the skin, and when there is no fever produce perspiration 
without stimulating. They also seem to increase the biliary and intes- 



SPECIAL SEDATIVES. 181 

tinal secretion. In inflammation and fever, larger doses are required to 
produce the same result; and as soon as the excessive arterial tension 
is relaxed, the chief part of the fever is removed. By thus reducing 
the increased tonicity of the arteries, the circulation is equalized and 
quieted, and the determination to and distention of the inflamed part 
are diminished ; and the vessels generally are placed in the condition 
for their natural offices of secretion, which their extreme tension had 
before interrupted." " This view," he properly remarks, "is at pre- 
sent no more than hypothetical, and might with advantage be tested by 
experiments on the lower animals." 



SPECIAL SEDATIVES. 

1. AC'IDUM HYDROCYAN'ICUM .— HYDROCYANIC ACID. 

Diluted Hydrocyanic, Prussic, or Cyanohydric Mcid, combined with 
essential oils in certain vegetables, has been long employed as a thera- 
peutical agent ; but it was not much recommended in a separate state until 
about thirty years ago. It exists in the distilled water of Laurocerasus, 
and of bitter almond, as well as in the expressed juice of the leaves of 
Laurocerasus, the peach, &c. Its chief source, however, is in animal 
matters subjected to heat in contact with alkaline substances. 

The Pharmacopoeia of the United States, edition 1842, adopts the 
process of the London Pharmacopoeia for the formation of the acid, 
which consists in separating it by the reaction of dilute sulphuric acid 
on ferrocyanuret of potassium. When wanted for immediate use, it is 
directed to be prepared by the action of dilute muriatic addon cyanuret 
of silver. By the double decomposition that ensues, hydrocyanic acid 
is formed, which dissolves in the water, and the chloride of silver sub- 
sides. The clear liquor is then poured off, and kept for use. 

Hydrocyanic acid, thus prepared, is colourless ; of a peculiar odour, 
and wholly volatilisable by heat. One hundred grains produce with 
solution of nitrate of silver a white precipitate, which, when washed 
and dried, weighs 10 grains, and is readily dissolved by boiling nitric 
acid. It contains 2 per cent, of pure anhydrous acid, and has a charac- 
teristic odour. This must not be confounded with that of the oil of 
bitter almonds, which is decidedly different, and is much more depen- 
dent upon a true essential oil than on the concomitant hydrocyanic acid. 
(Christison.) It should be kept in closely stopped bottles, from which 
the light is excluded. Some have supposed that glass stoppers are ab- 
solutely necessary for its preservation ; but this has been denied. 

Hydrocyanic acid is usually classed amongst narcotic poisons ; yet 
there is reason to believe, that its ordinaiy effects are purely sedative. 
Whilst agents belonging to the class of narcotics produce, first of all, ex- 
citation in the organic actions, followed, sooner or later, when the agent 
is in sufficient dose, by signs of sedation ; this acid occasions the latter 



182 SPECIAL SEDATIVES. 



results only. Of the rapidity of its action, in highly poisonous doses, 
mention has already been made. 

When given in rather too strong a dose, or, if in proper doses, at too 
short intervals, it produces headache, and vertigo, which go off, how- 
ever, in a few minutes. With regard to the parts of the economy that 
are primarly acted upon by it, there can be but little hesitation in de- 
signating the nervous system. In no other way can we readily explain 
the extreme rapidity of its operation in fatal cases ; yet when mixed with 
the blood out of the body, it altogether changes the character of that 
fluid, and opposes its coagulation. 

From what has been said of its action, it is easy to infer the morbid 
cases in which the acid may be indicated. It is decidedly sedative, 
allaying nervous irritability and vascular action ; and, therefore, adapted 
for all cases in which these are unusually excited. Yet its power, as a 
medicinal agent, is not as great as was at one time presumed ; and is 
still presumed by many. The great objections that have been urged 
against it are, — its dangers, even in a small dose, if not cautiously ad- 
ministered ; the difficulty of having it always of the same strength ; the 
impracticability of administering it undiluted ; and the danger of giving 
too strong a dose, in consequence of its rising to the surface of water. 
More than once, too, the difference in the strength of the acid prepared 
by different methods would seem to have given rise to unfortunate re- 
sults. The case of a sick person is mentioned by M. Orfila, who had used 
it for a length of time, in increasing doses, with advantage ; but, being 
compelled to send her prescription to another apothecary, the acid 
returned was so strong as to produce death with all the symptoms of 
poisoning by hydrocyanic acid. For these and other reasons, many of 
the German physicians prefer cherry-laurel water and water of bitter 
almonds, which, although in other respects not less objectionable, are 
less dangerous. Sir George Lefevre, indeed, affirms, that cherry-laurel 
water — Aqua Laurocerasi is a far more effective preparation than hydro- 
cyanic acid. In many nervous affections, as palpitation, hysteria, &c, 
he generally prescribes the following draught : 

R. A quae lauro-cerasi Tr^xx. 

flor. aurantii f.Jj. 

Syrup, tolut. f.^j. M. 

The draught to be taken pro re nata. 

The author has frequently employed hydrocyanic acid and its com- 
pounds, where a sedative agent has appeared to be needed, but the 
results have .not satisfied him that they were owing to the remedy ad- 
ministered. It has been conceived to be especially appropriate in 
diseases that depend upon increased irritability of the nervous system, 
and in those connected with excessive sensibility. In fevers — inter- 
mittent or continued — it is rarely used. It is affirmed by Dr. A. T. 
Thomson, that in no kind of idiopathic fever has it been employed ; 
but in this he is mistaken. There are practitioners, who have prescribed, 
and continue to prescribe it, in such affections. By many it has been 



ACIDUM HYDROCYANICUM. 183 

esteemed beneficial in hectic fever; but here, again, its agency is 
doubtful. In all the phlegmasia?, and in every kind of hyperemia, simple 
or accompanied with hemorrhage, it has been tried, and numerous tes- 
timonials have been offered in its favour. Even in the formidable 
disease, phthisis, it has been extolled as a moderator of the cough, and 
adiminisher of the hectic. It is, however, in diseases belonging to the 
class spasmi of Cullen, that its powers are looked upon as most con- 
spicuous, — in diseases, it must be admitted, in which it is difficult to 
appreciate therapeutical agencies. In asthma, even when the pulse was 
small, irregular, and often not easily distinguishable, it is said to have 
acted almost like a charm, — removing the oppressed breathing, and re- 
storing the free play of the respiratory organs ; and in hooping cough 
it has been conceived by Dr. Roe to possess almost a ' specific' power. 
" I do not think," says another observer, Dr. A. T. Thomson, i( I am 
stretching my praise of it too far, in affirming that few cases of this 
disease would prove fatal, were the hydrocyanic acid early resorted to, 
and judiciously administered. After emptying the stomach with an 
emetic, and purging briskly, the use of the acid should be begun, and 
the prescription never altered, except to increase the dose of the acid. 
When thus treated, the disease seldom continues more than a month 
or five weeks." "It is necessary," he adds, "to confine the little 
patients to a graduated temperature, and to keep them altogether upon 
a milk and vegetable diet." 

The author has often used hydrocyanic acid in hooping-cough, and 
endeavoured to observe its effects carefully ; but the results have not 
been such as to enable him to place reliance upon it. It certainly has 
not answered, in his hands, in the very cases mentioned by Dr. Thomson, 
half as well as narcotics given so as to produce a sedative influence. 

In various neuropathic disorders of the stomach, especially in those 
in which pain at the epigastrium was the leading symptom ; in every 
form, indeed, of gastrodynia, and in painful affections of the bowels of 
a similar character, it has been found useful ; as well as in chronic 
vomiting, connected or v not with organic disease. It has, likewise, 
been given in neuralgia with great benefit. 

Externally, it has been employed in numerous cases; — as a soothing 
agent in severe pain, — as in toothache ; diluted, as a lotion in painful 
wounds ; as an injection in fistula ; and, associated with belladonna, as 
a cataplasm in neuralgia. In various forms of cutaneous disease, it has 
allayed irritation ; associated with infusion of belladonna, it has been 
thrown into the vagina in cases of uterine pain from scirrhus ; and has 
been used as an injection in blennorrhea. It is almost impracticable, 
however, to enumerate the different morbid conditions in which it has 
been prescribed. If the practitioner will bear in mind the effects, which 
it is capable of inducing upon healthy man, when the dose is carried 
to the requisite extent, he will have no difficulty in deciding upon the 
pases in which its agency may be appropriate. If not a true sedative, 
it is the nearest approach to one in the lists of the materia medica ; and 
its employment is, therefore, clearly suggested in all diseases in which 
there is erethism, — administered alone, or along with other agents of 
the same class. 



184 



SPECIAL SEDATIVES. 



The dose is one or two drops in a table-spoonful of any simple men- 
struum increasing the dose gradually by one drop, until some effect is 
perceptible, either on the patient or on the disease. The most common 
on the patient is a peculiar impression in the back of the throat, with 
sluggishness in the movements of the tongue. "There is no distinct 
evidence of its being a cumulative poison, though this has been at 
times suspected. Its operation must be diligently watched at first, till 
the proper dose be ascertained. This is the only secret for using it 
with safety and confidence." (Christison.) The ordinary strength of 
a lotion for cutaneous affections and painful ulcers is one part of the 
acid to two hundred of water; but the strength may be increased to 
twice or thrice this amount. Sometimes rectified spirit is added to it. 
A lotion of f.3i to f.Jiv of the acid to a pint of the decoction of common 
mallow has been used in acne and impetigo to diminish itching ; and 
in ulcerated cancer to allay pain. It is important to bear in mind, that 
in these cases it affects the system, inducing giddiness and famtness; 
so that great caution is needed. 

2. POTAS'SII FERROCYANURE'TUM.— FERROCYAN'URET OF POTAS'SIUM. 

Ferrocyanuret of potassium, Ferrocyanide of potassium, Prussiate of 
potassa, Ferroprussiate of potassa, is prepared on the large scale, by 
calcining animal matters with pearlash in a red hot iron crucible ; dis- 
solving the cold calcined mass in water; concentrating, and crystallizing. 
It may, likewise, be prepared by boiling purified Prussian blue in solu- 
tion of potassa, till the blue colour disappears; and then crystallizing. 

The salt, thus formed, is a double cyanuret of potassium and iron. 
It is in crystals of a lemon colour, which are wholly soluble in four 
parts of temperate, and two parts of boiling water; but is insoluble in 
alcohol. It is in the materia medica list of the Pharmacopoeia of the 
United States. 

Ferrocyanuret of potassium is very rarely used in medicine. It 
would seem, indeed, to be inert or nearly so. Half a pound of a solu- 
tion of it has been swallowed ; and a drachm, and two drachms have 
been given without any inconvenience. (Christison.) On the other hand, 
one writer,— Dr. Smart, of Maine,— regards it as a valuable sedative in 
febrile and inflammatory cases. He ascribes astringent powers to it in 
the colliquative sweats of phthisis ; and affirms that it sometimes in- 
duces ptyalism, unattended with the fcetor which forms part of mercurial 
ptyalism. He, likewise, found it of service in neuralgia, and in hoop- 
ing-cough. In an over-dose, it occasioned giddiness, coldness, and 
numbness, with sense of sinking in the epigastric region. _ Notwith- 
standing, however, the recommendation of Dr. Smart, it is scarcely 
ever prescribed. The author has watched its effects in the sweating of 
phthisis, but has never witnessed the slightest benefit from it. The 
dose recommended by Dr. Smart is ten or fifteen grains dissolved in 
water, repeated every four or six hours. 



POTASSII CYANURETUM. 185 

The salt is chiefly used for the preparation of 

3. POTAS'SII CYANURE'TUM.— CYAN'URET OF POTAS'SIUM. 

Cyanuret or Cyanide of potassium — received into the edition of the 
Pharmacopceia of the United States, for 1842, as one of the prepara- 
tions — is made by exposing Ferrocyanuret of potassium — the salt last 
mentioned — to a moderate heat until it becomes nearly white. It is 
then exposed to a red heat until gas ceases to be disengaged ; distilled 
water is now added to it when cold, and it is evaporated to dryness. 
In this process, the cyanuret of iron is decomposed, and that of the 
potassium remains. It is soiled, however, by the iron, and the char- 
coal belonging to the cyanuret of iron. When the mass is dissolved 
in water, the iron and charcoal are deposited ; the cyanuret of potassium 
is dissolved, and is obtained by evaporating to dryness. 

The dry salt obtained, must be kept in a closely stopped bottle. It 
is a white powder, having a sharp, somewhat alkaline and bitter almond 
taste, and an alkaline reaction. It deliquesces in moist air; is very 
soluble in water, and sparingly so in alcohol. 

Cyanuret of potassium has all the properties of hydrocyanic acid for 
which it has been recommended as a substitute. Dr. Letheby states, as 
the result of his experiments on animals, that with the exception of 
hydrocyanic acid of the strength of four per cent., cyanuret of potas- 
sium is the most virulent and active of all the compounds into which 
cyanogen enters. It has been advised, that it should be dissolved in 
eight times its weight of distilled water ; and to this solution M. Magen- 
die gives the name • medicinal hydrocyanate of potassa,' and advises, 
that it should be prescribed under the same circumstances, and in the 
same doses, as medicinal hydrocyanic acid. He farther suggests, that 
to render it wholly independent of the action of the small portion 
of alkali contained in the cyanuret, a few drops of some vege- 
table acid may be added ; or it may be prescribed w 7 ith an acid 
syrup. The dose is a quarter of a grain, which may be gradually 
increased to a grain or more. It has been employed advantageously as 
an external application in facial, sciatic and other forms of neuralgia ; 
in the form of lotion, (Potass. Cyanur. gr. i— iv ; Jiquas f.|j ;) and of 
ointment, (Potass. Cyanur. gr. ij— iv; JLdipis gj.) Added to poultices, 
it is affirmed to have relieved the pain of white swelling. M. Andral 
employed it with complete success in a case of intense cephalalgia, 
which, for ten months, had resisted the most powerful remedies, — as 
bleeding, a seton in the neck, blisters and sinapisms. It was used in 
solution in the proportion of six or eight grains to the fluidounce of dis- 
tilled water ; and compresses, wet with it, were applied, for eight days, 
to the forehead and temple. 



Recently, Sulpho-cyan'uret of potas'sium, Potas'sii Sulpho-cyanu- 
re'tum, has been proposed by Sommering as a substitute for hydrocyanic 
acid and cyanuret of potassium,— on the ground, that it possesses the 
same therapeutical virtues without the inconveniences. 



N 



186 SPECIAL SEDATIVES. 



4. DIGITA'LIS.— FOXGLOVE. 



The leaves of Digitalis purpurea — the pharmacological history of 
which has been given elsewhere, (Vol. i. p. 286,) are unquestionably re- 
ferable to the class of acro-narcotic poisons, when administered in a 
large dose. In ordinary doses, their effect on the circulation is seda- 
tive, — diminishing its force and frequency, and acting as a diuretic. In 
larger doses, it affects the alimentary canal, inducing nausea and vomit- 
ing ; and also the cerebro-spinal system, causing stupor ; and, in very 
large doses, coma, convulsions, and death. A slow, feeble, and irregular 
pulse results, with cold sweats. Its operation on the nervous and cir- 
culatory organs has been observed by some to be preceded by manifest 
excitement; by others, however, this has not been witnessed. The 
author has watched attentively during its administration, but has not 
been able to satisfy himself of the existence of any precursory excite- 
ment. " The publications of Rush, Rasori, and Tommasini," says a 
recent writer — Dr. Billing—" would, I think, satisfy any person that 
digitalis is a sedative, (' contra-stimulant,') though, up to this time, not 
a year passes in which the pages of periodicals are not loaded with 
attempts to prove it a stimulant." At times, the pulse is reduced by it 
as low as 35 beats in the minute. Along with this reduction, when 
the remedy has been given for some days, there is generally a feeling 
of great languor, often with anxiety, nausea, vertigo, dimness of vision, 
headache and delirium ; and if the doses be still continued, these symp- 
toms may be followed by those of true poisoning. 

Not only are .the effects of digitalis induced when the remedy is taken 
by the mouth, but they equally supervene when it is injected into the 
rectum or the venous system. 

It has often been remarked, that after it has been given in ordinary 
doses for a time, without producing any constitutional effect, and 
certainly none of poisoning, it may suddenly explode, as it were, and 
produce alarming consequences : hence the caution usually inculcated 
against administering it too vigorously, even when its effects are not 
apparent. Death, we are told, has resulted in numerous instances from 
its employment. Yet there are several authenticated instances in which 
it has been given to a great extent with entire impunity. The author 
recollects being struck with the freedom with which the tincture was 
directed by Professor James Hamilton, jun., of the University of Edin- 
burgh, in diseases of women and children that are attended with much 
vascular excitement ; and there are practitioners who give f.iss or f.^j 
with much less effect than might be supposed. Dr. Pereira cites the 
following communication from an old preceptor of his own, as well as 
of the author — Dr. Clutterbuck — in illustration of this point. " My first 
information on this subject was derived from an intelligent pupil, who 
had been an assistant to Mr. King, a highly respectable practitioner at 
Saxmundhara, in Suffolk, who, on a subsequent occasion, personally 
confirmed the statement. This gentleman assured me, that he had been 
for many years in the habit of administering the tincture of digitalis, to 
the extent of from half an ounce to an ounce at the time, not only with 



DIGITALIS. 



187 



i 



safety, but with the most decided advantage, as a remedy for acute in- 
flammation, — not, however, to the exclusion of blood-letting, which, on 
the contrary, he previously uses with considerable freedom. To adults 
he gives an ounce of the tincture, (seldom less than half an ounce,) and 
awaits the result of twenty-four hours ; when, if he does not find the 
pulse subdued, or rendered irregular by it, he repeats the dose ; and 
this, he says, seldom fails to lower the pulse in the degree wished for ; 
and when this is the case, the disease rarely fails to give way, provided 
it has not gone the length of producing disorganization of the part. He 
has given as much as two drachms to a child of nine months. Some- 
times vomiting quickly follows these large doses of the digitalis, but 
never any dangerous symptom, as far as his observation has gone, which 
has been very extensive. In less acute cases, he sometimes gives 
smaller doses, as thirty drops, several times in a day. * Such,' adds Dr. 
Clutterbuck, * is the account I received from Mr. King himself, and 
which was confirmed by his assistant, who prepared his medicines. I 
do not see any ground for questioning the faithfulness of the report. I 
have myself exhibited the tincture to the extent of half an ounce 
(never more) in not more than two or three instances, (cases of fever 
and pneumonia). To my surprise there was no striking effect produced 
by it, but I did not venture to repeat the dose. In numerous instances 
I have given two drachms, still more frequently one drachm ; but not 
oftener than once in twenty-four hours, and not beyond a second or 
third time. Two or three exhibitions of this kind I have generally ob- 
served to be followed by slowness and irregularity of pulse, when I 
have immediately desisted.'" 

When the effects of digitalis on the circulatory system were first ob- 
served, it was fancied that a substitute had been found for the lancet 
in febrile and inflammatory diseases ; and some time even after that 
period, it was highly extolled as a contra-stimulant by Rasori and his 
followers. It is rarely, however, employed in simple fever ; and neither 
in it nor in inflammation, can it be substituted for the lancet. It may, 
however, be used with advantage after blood-letting, and especially 
when inflammation has gone on for some time, and terminated in serous 
effusion. As a mere antiphlogistic, it is rarely trusted to in those cases. 

The circumstances that guide us in its administration in inflammation 
apply equally to hemorrhages, in which it is very commonly directed 
after antiphlogistics ; yet but little faith is placed in its remedial agency, 
in these cases, by Dr. Christison. It certainly ought not to interfere 
with the employment of other remedies. It has been highly extolled in 
haemoptysis ; but in no disease is there more difficulty in deciding as to 
the precise effect of any particular remedy ; as the hemorrhage gene- 
rally ceases, after a time, of itself, and hence so many internal astrin- 
gents are recommended, which often certainly can have but little 
influence, the curative effect being mainly, and perhaps altogether, in- 
duced by the treatment on general principles pursued along with them. 

In diseases of the heart, accompanied by augmented action, digitalis 
would appear to be indicated, and it is, accordingly, much prescribed 
in hypertrophy of that organ, both when simple and accompanied by 
dilatation, as well as in the various affections in which the heart's action 



188 SPECIAL SEDATIVES. 

is irregularly exerted, — as in angina pectoris, neuralgia, &c, or where 
there is an accompanying dropsical effusion, when its diuretic action 
also becomes serviceable. 

At one time, in phthisis, it was considered to be capable of arresting 
the disease ; and, when its constitutional influence is induced, the 
symptoms often appear to be suspended ; but in every case that has 
fallen under the author's notice, they have subsequently recurred. It 
has the power of diminishing the velocity of the circulation ; but it must 
be borne in mind, that this velocity is a mere symptom of the patholo- 
gical condition — the tuberculosis. 

In some of the neuroses, it has been prescribed freely, as in mania, 
epilepsy, and even in delirium tremens ; as well as in certain spas- 
modic diseases, as asthma and hooping-cough ; in some of which it has, 
undoubtedly, been given empirically. It is not easy, for example, to 
see on what principle it has been prescribed in very large doses in de- 
lirium tremens. 

After all, the effects which it is known to exert, and which have been 
described above, will suggest the pathological states in which it is most 
likely to prove of service. 

The ordinary dose of the powder is a grain or a grain and a half, re- 
peated three times a day, gradually increasing the dose — under the 
precautions already laid down — until some constitutional effect is per- 
ceptible. The dose of INFUSUM DIGITALIS, (Vol. i. p. 289,) is f.gss to 
f. §j ; and of TINCTURA DIGITALIS, (Ibid.) %% to "Ixx three times a day. 
From numerous experiments, Dr. Munk has recently recommended the 
tincture as acting with the greatest certainty and effect upon the heart. 

Digitalis has been applied locally to scrofulous ulcers, and especially 
to ulcers that are attended with an excess of inflammatory action, in the 
form of a liniment made with the powdered leaves and honey. In 
such cases the sedative action of the drug is exerted, and an improve- 
ment seems to be effected on the system of nutrition of the part, as 
manifested by the improvement in the discharge and appearance of the 
ulcer. 



Digitalin — the active principle of digitalis — described elsewhere 
(Vol. i. p. 290,) as having been separated by MM. Homolle and Que- 
venne, is a most energetic sedative. Those gentlemen found its action 
on the derma denuded by a blister to be so irritating as to forbid its 
endermic use. In experiments on their own persons, the action of 
digitalin on the heart was always manifest, and was commonly exhi- 
bited by a progressive diminution in the number of its pulsations, which 
were lowered in some cases to 40, and generally to 50 or 55 in the 
minute. Its influence on the circulation appeared to continue for seve- 
ral days after its administration had been discontinued. 

It appears to possess all the active properties of digitalis. Its action, 
however, is most energetic ; and, consequently, it requires to be given 
with the greatest circumspection. MM. Homolle and Quevenne have 
found, from comparative trials, that four milligrammes (gr. .0616) of 



COLCHICI RADIX ET SEMEN. 



189 



Fig. 154. 



digitalin correspond in energy of action to about eight French grains 
(gr. 6.56) of digitalis ;— M. Bouchardat says to gr. 6.176 Troy. It is a 
hundred-fold stronger than the most active preparation of digitalis. 
(New Remedies, 5th edit. p. 248, Philad. 1846.) 

5. COI/CHICI RADIX.— COL'CHICTJM ROOT. 

AND 

6. COL'CHICI SEMEN.— COL'CHICUM SEED. 

The cormus and seeds of Colchicum autumnale, Meadow Saffron; 
Sex. Syst. Hexandria Trigynia ; Nat. Ord. Colchicacese, — Melanlha- 
cese; (Lindley,) are officinal in the Pharmacopoeia of the United States. 
The plant inhabits moist, rich meadows, 
in many parts of England and in vari- 
ous parts of Europe ; and is an autum- 
nal ornament of the gardens,— the flow- 
ers appearing in September, and the 
fruit in the following spring or summer. 
Various attempts have been made to in- 
troduce its culture into this country, 
with no great success, although small 
quantities of the bulb raised here, appa- 
rently of good quality, are said to have 
been brought to market. (Wood & 
Bache.) 

The bulb is considered to be most 
active in June or July ; at which time 
it is fully developed, and has not been 
exhausted by the production of the 
flower. The seeds must be gathered 
when ripe. The fresh cormus or root 
is about the size of a chestnut, and re- 
sembles in shape and size that of the 
tulip ; but differs from it in the latter 
being in scales ; whilst that of colchi- 
cum is solid. It is convex on one side ; 
and flattened on the other, where the germ of a new cormus is percep- 
tible, which, if it be allowed to grow, shoots into a stem, and bears the 
flower ; — the old cormus, in the mean time, wastes away and becomes 
inert. This germ, in the opinion of Dr. J. R. Coxe, distinguishes the 
cormus of colchicum from all others ; but it is affirmed that it is not 
always present. Internally, the cormus is white and fleshy ; contains 
a milky juice ; and has an acrid, bitter taste. 

To dry.the root, it has been recommended, that the dry coats should 
be removed; that it should be cut transversely in thin slices, and be 
quickly dried in a dark airy place, at a temperature not exceeding 150° 
or 170°. These slices— if the drug be in good preservation — are firm ; 
dry; of a grayish white colour, and an amylaceous appearance. 

Colchicum seeds are about the size of white mustard seeds ; devoid 
of smell ; and of a bitter, acrid taste. 




Colchicum autumnale. 
Closed Capsule. 2. Open do. 3. Styles 
4. Section of Capsules. 5. Seed. 



190 SPECIAL SEDATIVES. 

The flowers are not officinal. They are the mildest part of the 
plant; and hav r e been successfully administered by several English phy- 
sicians. 

Colchicum imparts its virtues to water and to alcohol ; but still better 
to vinegar, and wine, or to diluted spirit of the same strength. Hence, 
distilled vinegar and wine are used as menstrua for two officinal prepa- 
rations that are much employed. The cormus has been analyzed by 
different chemists. At one time, it was believed by MM. Pelletier and 
Caventou to contain veratria, but from the examination of Messrs. 
Geiger and Hesse, it appeared, that the active principle was seated in 
an alkaloid closely analogous to, but not identical with veratria, to 
which they gave the name Colchicine or Colchicia. This is found in 
every part of the plant, crystallizing in slender needles; inodorous; 
and of a very bitter, and afterwards biting taste. Introduced into the 
nose, it dose not, like veratria, induce sneezing. 

In its effects upon the system, it seems to resemble somewhat digi- 
talis ; — rendering the pulse less frequent. 

In excessive doses, it is a poison of the acro-narcotic class. It is 
avoided by cattle, and its active poisonous properties have been long 
known: fatal cases, indeed, occur every now and then from its use, not 
only in animals, but in man, owing to its too free employment in the 
treatment of gout. Reynolds — the inventor of the wine of colchicum, 
commonly called Reynolds^s Specific — is said to have killed himself by 
an overdose ; and other fatal cases are recorded. It is said to excite 
occasionally profuse ptyalism. 

It appears to be the hermodactyl of the ancients, and was extensively 
employed by them ; but had fallen into almost entire neglect, when its 
use was revived in Great Britain, in the first quarter of the present cen- 
tury, as an efficacious agent in gouty and rheumatic affections; and it 
is now introduced into almost every pharmacopoeia. V 

In gouty and rheumatic cases, its action has been regarded by some 
as "specific;" others have ascribed its efficacy in these cases to its 
action on the kidneys. It is most probable, that its agency is mainly 
exerted on the nervous system; although it certainly is not easy to 
explain the precise modus operandi. The Eau medicinale d'Husson was 
long a celebrated gout remedy ; and was extensively used by men of 
the first scientific eminence. Many trials were, consequently, made to 
discover its constituents. These are now considered to be colchicum 
root, macerated in wine: — the Vinum colchici, to be described pre- 
sently; and it is singular, connected with this discovery made by Mr. 
Want, that whilst he was directing attention to colchicum, another 
investigator had satisfied himself that veratrum album was the basis: 
it has been since shown, that the active principles of the two substances 
are analogous. 

In acute rheumatism, and in various inflammatory diseases, colchi- 
cum was proposed and extensively used by the author's valued and 
able friend, the late Mr. C. T. Haden, of London, as an excellent 
sedative to reduce excited organic actions, which he thought it was 
capable of effecting to such an extent that blood-letting might generally 
be rendered unnecessary in febrile and inflammatory disorders ; and the 



COLCHICI RADIX ET SEMEN. 191 

views of Mr. Haden have been in some degree confirmed by others. 
The author has often exhibited the different preparations of colchicum 
in gout; and, frequently, with decided advantage; but very often it 
has wholly failed. In his own case, it has never exerted any power 
over the disease. In acute and chronic rheumatism, its advantages 
have not seemed to him so marked as they have to some. Like other 
acro-narcotics — cimicifuga for example, when carried to the extent of 
slightly affecting the system, as shown by nausea, with cerebral con- 
fusion—it has, at times, effected a revulsion, which has broken the chain 
in acute rheumatism. In chronic rheumatism, it has exhibited less 
marked results; yet there is no agent, perhaps, which is so much em- 
ployed in rheumatic affections. In none of these cases, according to 
most observers, need any sensible evacuation be produced by it; 
although some have affirmed— and such certainly is the result of the 
author's observation—that it is more efficient, when it evinces its influ- 
ence upon the skin or alimentary canal. Dr. Wigan asserts, that he 
gives it in rheumatic gout in the dose of eight grains every hour, until 
"active vomiting, profuse purging, or abundant perspiration takes 
place, or at least until the stomach can bear no more;" and, when 
thus administered, he pronounces it to be "the most easily managed, 
the most universally applicable, the safest, and the most certain spe- 
cific [?] in the whole compass of our opulent pharmacopceia." 

Colchicum has, likewise, been given in tetanus of warm climates, 
chronic bronchitis, leucorrhcea, scarlatina, ischuria, prurigo, erysipelas ; 
and it is said to have been prescribed successfully in tape-worm. It is 
sometimes used externally as a liniment to rheumatic joints, in the form 
of the tincture of the seeds or bulb. 

The dose of the powdered root is from three grains to ten, given 
several times a day. - 

Dr. Holland affirms, that he knows no preparation more certain in 
effect, or better capable of fulfilling the peculiar purposes of the medi- 
cine, than the acetous extract. 

TINCTU'RA COLXHICI SEM'INIS, TINCTURE OF COLCHICUM SEED. (Colchic. 
semm. contus. 3iv; Mcohol. dilut. Oij-prepared either by maceration 
or displacement.) The dose of this preparation is from gtt. x to f.^i. 
Dr. Pereira states, that he has often given f.^ij at a dose without any 
violent effect; and Dr. Barlow, who prefers this to the other prepara- 
10ns of colchicum, advises that in gout f.^j, f.3iss or f.3ij of the tinc- 
ture should be given at night, and repeated in the following morning. 
If his quantity fail to purge briskly, a third dose is administered on the 
iollowing night. 

The tincture is sometimes used externally in gout. For this purpose, 
it has been recommended to mix two fluidrachms of it with four fluid- 
ounces of a spirit lotion ; but it is affirmed, that the local use of morphia 
had the same effect,-the part being bathed in hot water for a minute, 
and then lint applied spread with simple cerate, on which about three 
grains of acetate of morphia were distributed. More recently, the 
tincture of the root has been advised as an external application in 
rneumatism,-alone, or combined with tindura camphora. It was much 



1 92 SPECIAL SEDATIVES. 

used at the author's Clinique in the Philadelphia Hospital, and often 
with advantage ; but whether much or any benefit was produced by the 
colchicum, the author was unable to decide. 

VINUM COL'CHICI RADI'CIS, WINE OF COL'CHICUM ROOT. (Colchic. radio. 
contus, fBj ; Vini Oij — prepared by maceration or displacement.) This 
is intended to be a saturated tincture. The dose is from ten minims to 
a fluidrachm ; repeated until some effect is induced. 

Sir Everard Home ascribed much of the griping and nausea that 
sometimes follow the use of this and other tinctures of colchicum, 
which have not been carefully filtered, to the sediment that forms in 
them, and which may be removed without injury to the desired effect 
of the remedy. It would appear, however, that this sediment is inert. 

VINUM COL'CHICI SEM'INIS, WINE OP COL'CHICUM SEED. {Colchic. Son. 
contus. 3iv ; Vini Oij.) This is in none of the British Pharmacopoeias. 
It is the wine which was so much used by Dr. Williams in gout. The 
dose is f.3j to f.3ij- 

ACETUM COL'CHICI, VINEGAR OF COL'CHICUM. (See Vol. i. p. 290.) This 
preparation is more frequently given as a diuretic in dropsy; and in 
gouty and rheumatic cases. The acetic acid unites with the alkaloid 
and forms Acetate of colchicia, which is supposed by some to be equally 
active with colchicia itself. Sir C. Scudamore, however, combines it 
with magnesia, in order that an acetate of magnesia may be formed, 
and the colchicia be left in the most favourable condition for adminis- 
tration. A mixture, proposed by him for gouty cases, which has re- 
ceived the name of Scudamore's mixture, is thus made — (Magnes. 
sulphat. 5j — ^ij ; solve in Aq. menth. crisp, f.^x; adde Acet. colchic. 
f.5j — 5iss ; Syrup. Croci f.5j ; Magnes. 9viij. — M. Dose f.giss, so that 
from four to six evacuations may be produced in twenty-four hours.) 

7. VERA'TRIA. 

Veratria is the active principle of the seeds of Veratrum Sabadilla, 
V. officinale, Helonias officinalis, and Asagrcea officinalis, which are 
known in commerce under the names Cebadilla, Cevadilla, or Sabadilla, 
and are imported from Vera Cruz and Mexico. They usually occur in 
commerce mixed with the fruit of the plant ; are two or three lines long; 
of a black colour, and are shining, flat, shrivelled, winged and elastic 
seeds. Veratrum Sabadilla belongs to Sex. Syst. Polygamia Moncecia ; 
Nat. Ord. Colchicacese, — Melanthacese of Lindley ; and Asagrcea offi- 
cinalis, to Sex. Syst. Hexandria Trigynia ; Nat. Ord. Melanthacese. 

Although cevadilla is applicable to all the cases in which veratria is 
used, it is still rarely employed. A saturated tincture of the seeds is 
occasionally prescribed as a rubefacient liniment in chronic rheumatism 
and paralysis ; and is rubbed over the heart in nervous palpitation. 

The rationale of the process for obtaining Vera'tria, Ver'atrine, or 



VERATRIA. 193 

Sabadill'in, in the Pharmacopoeia of the United States, (1842,) is as fol- 
lows. Bruised Cevadilla is boiled in fresh portions of alcohol for three 
times; the cevadilla is then pressed; and the alcoholic solutions, con- 
taining veratria, united with a vegetable acid, are mixed. The alcohol 
is distilled off; and the residue is boiled three or four times in water 
adulterated with sulphuric acid, by which means an impure solution of 
sulphate of veratria is obtained. The liquors are mixed, strained, and 
evaporated to the consistence of syrup. Magnesia is now added in 
slight excess, which decomposes the salts of veratria ; and sets the ve- 
ratria at liberty. The dried residuum is digested repeatedly in alcohol, 
which dissolves the veratria. The alcohol of the different digestions is 
mixed and distilled off. The residue is boiled in water with a little 
sulphuric acid and animal charcoal, the second of which unites with 
the veratria, whilst the third removes the colouring matter. The liquor 
is strained, and the residue thoroughly washed ; the washings being 
mixed with the strained liquor. It is then evaporated to the consist- 
ence of syrup, and as much solution of ammonia dropped in as may 
decompose the sulphate of veratria, and precipitate the veratria. The 
precipitate is lastly separated, and dried. 

Veratria is of a grayish white colour ; pulverulent ; devoid of odour ; 
and of a bitter acrid taste, producing a feeling of numbness and tingling 
when applied to the tongue. It is sparingly soluble in water, but 
readily so in alcohol, ether, and especially in weak acids, which it neu- 
tralizes. On account of its very high price, and the want of well de- 
fined external characters, the veratria of the shops is said to be very 
subject to adulteration ; and there would not seem to be any good cri- 
terion for ascertaining its degree of purity. (Christison.) 

Veratria is a most virulent acro-narcotic poison. Minute doses injected 
into the venous system have induced fatal tetanus. When taken inter- 
nally in medicinal doses, it causes heat in the mouth, nausea, and feel- 
ing of heat in the stomach and bowels, — at times, diarrhoea and head- 
ache, with depression of the heart's action. Applied externally, it 
excites a singular sense of pricking in the part, ajid occasionally the 
same cephalic heat and cardiac phenomena as result from its internal 
administration. Only in a few cases has any eruption followed its ap- 
plication. The endermic use of the remedy has always excited so much 
irritation as to prevent its repetition. 

Owing to its presumed effects on the nervous system, and especially 
on the spinal marrow and the nerves connected with it, the use of vera- 
tria was suggested in nervous diseases, particularly in neuralgia, proso- 
palgia, and ischias. A single friction is said to have been sufficient to 
remove the disease without relapse. Some advantage has likewise been 
experienced from its employment in chorea, hypochondriasis hysteria 
and paralysis, as well as in rheumatism and gout. Dr. Turnbull found 
it useful in glandular swellings, goitre, swellings of the mammary glands 
unaccompanied by pain, buboes, and scrofulous tumours, even in cases 
where iodine had failed. Farther experience is, perhaps, needed in 
regard to its virtues ; but the author must confess, that his own observa- 
tion has by no means confirmed the high-strained eulogies of Dr. Turn- 

Vol. II.— 13 



194 



SPECIAL SEDATIVES. 



bull • and this is the general sentiment of the profession. It has often 
been used externally by the author, as well as by many other American 
physicians; but has generally disappointed his expectations. Dr. 
Bardsley thinks it has the properties of colchicum, and may be used 
with equal advantage in the same cases. 

Tt may be given in pill, or in spirituous solution, — the dose being 
from one-twelfth to one-sixth of a grain several times a day. A Tinc- 
ture may be made of four grains to the fluidounce of alcohol; and of 
this, ten to twenty drops may be given for a dose in a glass of water. 
Externally, it is best used in the form of Ointment ;— ( Veratria gr. v, 

x, xx ; Adipis ^j.) A piece of the size of a 
Fig. 155. hazel-nut to be carefully rubbed in, morning 

and evening, or oftener, for from five to fifteen 

minutes. 

SULPHATE OF VERA'TRIA, made by the combi- 
nation of veratria with sulphuric acid, has the 
same virtues as veratria. M. Magendie has 
proposed the following solution as a substitute 
for Eau medicinale d'Husson in gout. (Vera- 
trix sulphat. gr. i ; *ftqu<e destillat. f.§ij. M. 
Dose f.^j to f-3iv.) 

8. VERA'TRUM ALBUM.— WHITE HEL'LEBORE. 

White hellebore is the rhizoma of Veratrum 
album ; Sex. Syst. Polygamia Moncecia ; Nat. 
^^ Ord. Colchicacese, — Melanthaceae, (Lindley;) 
veratrum Album. Linn. Var. a plant which grows in the mountainous re- 
gions of Europe, abounding in the Alps and 
Pyrenees, but is not a native of Britain. The root is brought to this 
country from Germany in the dried state ; and, as met with in the 
shops, is from two to four inches long, by an inch in diameter, having 
the shape of a cylinder, or more frequently of a truncated cone. It is 
rough ; rugous ; and of a grayish or blackish brown colour externally; 
internally, whitish ; and usually has portions of the root fibres detached 
from it : at times, the fibres remain attached. These are of a yel- 
lowish colour, and of the size of a crow's quill. The odour of the fresh 
root is disagreeable ; that of the dried feeble. The taste is at first bitter, 
and afterwards acrid. 

On analysis, w T hite hellebore yields veratria, the properties of which 
have been just considered. Another substance has, likewise, been 
announced in it, termed Jervin, — from Jerva, the Spanish name for a 
poison obtained from the root of white hellebore, the properties of which 
have not been accurately investigated. 

It is a powerful acro-narcotic poison ; and an active irritant ; hence 
it is one of the most potent errhines. (See Vol. i. p. 264.) In medi- 
cinal doses, unless very cautiously administered, it is apt to induce ex- 
cessive irritation of the gastro-enteric mucous membrane. It is said, 




VERATRUM VIRIDE. 195 

indeed, to have produced these effects when the rhizoma has been 
placed in contact with the cutaneous surface ; and especially when the 
cuticle has been removed. It appears to resemble greatly, in its effects, 
sabadilla and colchicum. 

In consequence of the occasional severity and uncertainty of its ope- 
ration, it is rarely given internally. Formerly, it was prescribed so as 
to induce its effects on the stomach and bowels in mania, melancholia, 
and other diseases of the nervous system, and, doubtless, at times acted 
beneficially as a revellent ; but it is now never prescribed. When great 
efforts were made to discover the composition of the celebrated gout 
remedy — Eau medicinale cPHusson — it was announced by Mr. Moore, 
that white hellebore was the chief ingredient ; but about the same time 
Mr. Want established, that a kindred plant— colchicum — was entitled 
to the credit. At that period, it was often prescribed in gout and 
rheumatism ; but, of late, has been almost wholly abandoned in favour 
of colchicum. Its chief use, at the present time, is as an external agent — 
an antiparasitic — in scabies, and to destroy pediculi. It is also used in 
porrigo, lepra, &c. The dose ought not, at first, to exceed one or two 
grains ; but it may be gradually increased. 

VINUM VERATRI ALBI, WINE OF WHITE HEL'LEBORE. (Veratri albi con- 
tus. 3iv ; Vini Oj.) This is the form in which white hellebore has been 
generally given in gout and rheumatism ; but it is not much used. The 
dose is Klx two or three times a day,~gradually increasing the quantity, 
until it exhibits some effect upon the constitution. 



9. VERA'TRUM VIR'IDE.— AMERICAN HEL'LEBORE. 

This is the rhizoma of Veratrum Viride^ Indian poke, poke root, and 
swamp hellebore, an indigenous plant, which is found in swamps and 
wet meadows, and on the banks of small streams, in almost all parts of 
the United States ; flowering from May to July. The root is collected 
in autumn, and ought not to be long kept. Its taste is bitter and acrid ; 
and its properties are probably dependent upon veratria. 

The medical properties of this rhizoma resemble those of colchicum 
and veratrum album. It is acro-narcotic in large doses; and reduces 
the force and frequency of the circulation in medicinal doses. Professor 
Tully, of New Haven, who has paid much attention to the virtues of 
indigenous plants, and especially to those of active powers, recommends 
it strongly as a substitute for colchicum. It has been chiefly given in 
gouty and rheumatic cases. The author has never prescribed it. It is 
said to prove emetic in the dose of from four to six grains of the pow- 
der ; but, as a sedative, the object is to give it short of inducing 
emesis, and yet to produce nausea or an approximation to it. The 
proper dose for this purpose will be two grains. It has been prescribed 
in the form of tincture and extract. Like veratrum album, it is used 
externally as an antiparasitic. 



196 



SPECIAL SEDATIVES. 



10. CIMICIF'UGA.— BLACK SNAKEROOT. 

Black snakeroot— the root of Cimicifuga racemosa, C. serpentaria, Ac 

tcea racemosa, Macrotrys race 



Fig. 156. 



mosa, Cohosh, Cohort, Bugbane 
— has been elevated, in the last 
edition of the Pharmacopoeia 
of the United States, from the 
secondary to the primary list. 
The plant is indigenous in the 
United States ; growing in 
shady and rocky woods from 
Canada to Florida. It belongs 
to Sex. Syst. Polyandria Di- 
pentagynia ; Nat. Ord. Ra- 
nunculaceae. It yields its 
virtues to boiling water and 
to alcohol ; and was found by 
Mr. Tilghman, of Philadelphia, 
to contain gum, starch, sugar, 
resin, wax, fatly matter, tannic 
and gallic acids, a black and 
green colouring matter, lignin, 
and salts of potassa, lime, 
magnesia and iron. 

Cimicifuga, in large doses, 
unquestionably belongs to the 
division of acro-narcotic poi- 
sons ; but the author has had 
difficulty in deciding as to 
what class of therapeutical 
agents it ought to be referred. 
It has appeared to him, how- 
ever, to exert an action ana- 
logous to that of colchicum ; 
and under this impression, he 
has placed it after that agent." 
The testimony of pharmacological writers, in regard to its action, is 
sufficiently imprecise, and this is shown by the following views of one 
of the most respectable of them, Dr. Wood, of Philadelphia. "Cimi- 
cifuga unites, with a tonic power, the property of stimulating the secre- 
tions, particularly those of the skin, kidneys, and pulmonary mucous 
membrane.' It is thought, also, by some to have a particular affinity for 
the uterus, and probably exerts some influence over the nervous system, 
of a nature not exactly understood. Its common name was probably 
derived from its supposed power of curing the disease arising from the 
bite of the rattlesnake. Till recently, it has been employed chiefly in 
domestic practice, as a remedy in rheumatism, dropsy, hysteria, and 




Cimicifuga racemes*. 
t 



ERGOTA. 197 

various affections of the lungs, particularly those resembling consump- 
tion." 

Some years ago, cimicifuga was largely employed in the author's 
wards in the Philadelphia Hospital, by two zealous resident physicians 
— Drs. E. A. Anderson, of Wilmington, N. C, and Alexander Vedder, 
of Schenectady, New York — who published cases illustrative of its 
powers in the treatment of rheumatism, in the ' American Medical In- 
telligencer,' for January 1, 1838, of which the author was editor ; and 
like other acro-narcotics, when pushed so as to produce catharsis, and 
even slight narcosis, it certainly appeared to be of service in the acute 
forms; and these results are confirmed by the recent observations of Dr. 
N. S. Davis. In its action on that disease it strongly resembled col- 
chicum. It is probably by virtue of similar powers, that it has been 
found beneficial in chorea, In some successful cases, published by Dr. 
Kirkbride, of Philadelphia, purging was premised ; and general frictions 
with salt or the flesh brush, and pustulation with croton oil over the 
spine, are considered by him of much value in the chronic cases. All 
these agents operate as revellents. The author has prescribed it re- 
peatedly in chorea, but has not had sufficient evidence of its having 
exerted any beneficial agency. In many of these cases a combined 
hygienic and therapeutic tonic treatment was subsequently followed by 
the disappearance of the disease. 

A modern writer, Dr. E. J. Wheeler, affirms, that by some eminent phy- 
sicians it has been thought a good substitute for the ergot in parturition. 
It is stated, however, by him to be dissimilar in its mode of action, re- 
laxing the 'parts and thereby rendering labour short and easy ; but 
evidence is required of its possessing any such powers ; and still more 
of its being of any service in incipient phthisis, or in " acute phthisis, 
uncomplicated with much inflammation in the vesicular structure or 
pulmonary mucous or serous membranes;" as has been affirmed by a 
recent writer. 

The dose of the powdered root may be half a drachm to a drachm, 
two or three times a day. It is most commonly, however, prescribed 
in decoction, (Cimicifug. contus. |j ; Jiqua Oj. To be boiled for a 
short time. Dose, f.^j to f.^ij several times a day.) The tincture is 
also given, {Cimicifug. contus. §iv ; Alcohol. Oj. Dose, gtt. xx three 
or four times a day.) 

11. ER'GOTA.— ERGOT. 

The eflects produced by ergot — whose general properties are de- 
scribed under Parturifacients, (Vol. i. 425,) when eaten as food, are 
extremely injurious, — the aggregate of the symptoms having been 
termed Ergotism. At times, these are limited to vertigo, spasms and 
convulsions, with a peculiar tingling or sense of formication in the arms 
and legs, which has given the affection, among the Germans, the name 
Kriebelkrankheit, " creeping disease." Most commonly, the limbs 
waste away, lose sensation and the power of motion ; and separate from 
the body by dry gangrene,— constituting gangrenous erethism or mildew 
mortification. Various experiments have been made by feeding ani- 



193 SPECIAL SEDATIVES. 

mals on ergot, and, although the results have been discordant, and, in 
many cases, none have been perceptible, there can be little doubt, that 
ergot exerts a poisonous influence on many animals, when mixed with 
their food. 

In another place, it is stated, that in his experiments on healthy in- 
dividuals, Jorg found, that symptoms of acro-narcosis were induced by 
ergot, when given in large doses; and that he explains the parturifacient 
effects of the drug by the violence done to the system of the mother. 
A short time ago, the author caused various experiments to be instituted 
on healthy persons as to the effects of ergot, in doses of half a drachm, 
and a scruple, of the powder, and in the form of an oily preparation 
pointed out by Professor Hooker, of New Haven. These experiments 
were made on both males and females ; and the general effects were 
those described by Jorg. When the dose was too large, nausea or 
vomiting often resulted with signs of narcosis. A case of narcosis, pro- 
duced by the drug, in the dose of thirty grains, administered with the 
view of restraining a real or supposed tendency to hemorrhage after the 
expulsion of the placenta, was also communicated to the author by Dr. 
Beckwith, of Raleigh, North Carolina. 

Elsewhere, (Vol. i. 429,) reference has been made to certain experi- 
ments by Professor Hooker, of New Haven, who digested ergot in ether, 
and evaporated the solution, until an oleaginous fluid was left, which 
consisted of a lighter supernatant oil, and a heavier. The lighter oil 
was found to be possessed of decidedly narcotic properties ; and in cer- 
tain experiments, made by Dr. McKee, at the author's suggestion, it 
was found, that in every case, when given in doses of from ten to forty 
drops, it at first produced slight exhilaration of spirits, with increase of 
the circulation ; but these symptoms were soon followed by sedation, 
and, in larger doses, by nausea also. It is, perhaps, by reason of those 
narcotic properties, that ergot has seemed to be serviceable in leucor- 
rhcea, gonorrhoea, dysentery, and other diseases of the mucous mem- 
branes, and in various hemorrhages, — epistaxis, haemoptysis, haemate- 
mesis, haematuria, &c. The author has often administered it in such 
cases, but has never had reason to believe that it exerted any efficacy; 
and such has been the case with other observers. It is proper, how- 
ever, to remark, that Dr. Wright found it, in the form of powder, very 
serviceable in arresting hemorrhage, and not simply in a mechanical 
manner as was proved by experiment. Even in the form of infusion, 
it possessed the power to an extraordinary degree. Dr. Wright affirms, 
that he has several times divided the external jugular, and the saphena 
major veins, and has never failed to arrest the flow of blood by an infu- 
sion of ergot, although with arteries he was generally less successful. 
In the greater number of experiments, he used a dilute solution of ergot, 
in place of warm water, to sponge the bruised parts, and always suc- 
ceeded in preventing that continued flow, which is often a serious ob- 
stacle to the safe direction of the knife. He, consequently, recommends 
it as a valuable means of preventing troublesome hemorrhage from small 
vessels in the course of surgical operations; and, upon the same prin- 
ciple, believes the injection of a similar solution into the uterus, in 



ACIDUM HYDROSULPHURICUM. 199 

cases of flooding, will be found to answer every practical end that can 
be desired.. 

A few years ago, M. Bonjean highly extolled a watery extract of 
er g t — to which he gave the name Ergotine — as a powerful haemastatic ; 
and a solution of it was known under the name Eau hSmastatique de 
Bonjean. M. Bonjean affirmed, contrary — as has been elsewhere 
shown — to the opinions of other observers, and to probability, that 
whilst ergotine contains the medicinal property of ergot, the oil and the 
resin contain the poisonous properties. He announced it as a real * spe- 
cific ' in hemorrhage in general. It was employed as a styptic in wounds 
of the capillary and larger vessels ; but the same fallacies appear to 
have existed as in the case of the matico, and the haemastatic waters 
already described, (Vol. ii. p. 132) ; and Drs. J. L. Smith and S. 
D. Sinkler, of Charleston, inferred from the results of a trial of the so- 
called ' ergotin,' on the divided carotid of a sheep, that it depends 
greatly, if not altogether, upon the manner in which the lint is applied 
to the wound of the artery, whether the hemorrhage is arrested or not. 
If placed immediately upon the orifice of the cut vessel, success is cer- 
tain ; if, however, the vessel shrinks from contact with the lint, the 
animal is almost certain to bleed to death. 

M. Bouchardat, in a recent Annuaire, (1848), after having done much, 
in his former volumes, to disseminate the views of M. Bonjean, re- 
marks ; — that " unhappily the facts, which he has adduced as support- 
ing his discovery, are still far from presenting the characters of satisfactory 
demonstration. As regards the success on animals, it is well known 
how plastic their tissues are, and with what ease they are repaired after 
serious injuries; and as respects the effects of ergotin on wounds in 
individuals of the human species, those that have been published 
hitherto may be attributed with probability to the circumstances that 
were associated with the application of the remedy, almost as much as to 
the action of the remedy itself." 

Ergot is said to have been serviceable in hypertrophy of the uterus, 
and has been supposed to act as an excitant to the spinal marrow : ac- 
cordingly, it has been administered in paraplegia, and in retention of 
urine, and, as has been conceived, with benefit. It has even been given 
to effect the expulsion of fragments of calculi after the operation of 
lithotrity ! Farther observation is, however, needed before we can 
regard all these statements to be accurate. 

The usual dose of the powder— the form generally chosen in these 
cases — is ten to fifteen grains three or four times a day. 

12. Tobacco, (Vol. i. p. 135,) and 13, Lobelia, (Vol. i. p. 133,) 
are likewise sedatives ; but their properties as nauseant sedatives are 
so fully described under Emetics, that it is unnecessary to add anything 
here. 

14. ACIDUM HYDROSULPHU'RICUM.— HYDROSULPH'URIC ACID. 

Hydrosulphuric Acid, Sulphohydric Acid, Hydrothionic Acid or 
Sulphuretted Hydrogen, is not officinal in the pharmacopoeias of Great 



200 SPECIAL SEDATIVES. 

Britain or of this country ; but it is admitted into many of those of con- 
tinental Europe as a sedative agent. It is an important ingredient, also, 
in sulphureous mineral waters. 

This gas is extremely deleterious ; killing instantly when breathed 
pure, and so powerfully penetrant, that it is sufficient to place an animal 
in a bag of it, without any of the gas entering the mouth, for it to act 
fatally. Even when mixed with a considerable portion of air, it may 
prove destructive. Birds perished immediately in air containing one 
thousandth part of it; a dog died in air containing one hundredth part, 
and a horse in air containing one hundred and fiftieth part. When 
breathed in a more diluted state, it produces powerfully sedative effects 
— the pulse being rendered extremely small and weak, the contractility 
of the muscular organs greatly enfeebled, with stupor, and more or less 
suspension of the encephalic functions ; and if the person should 
recover, he regains his strength very tardily. It is the gas which is so 
dangerous to nightmen, when they descend into the pits of privies. 

It has been advised in the way of inhalation, to diminish excitement 
in pulmonary affections, and especially in phthisis pulmonalis. It has 
been employed, also, successfully, in a case of obstinate cough that re- 
mained after an attack of pneumonia. It may be disengaged by pour- 
ing dilute sulphuric acid on sulphuret of pot ass a in a cup, and breathing 
the vapour cautiously through a funnel, — always bearing in mind its 
extremely deleterious properties. Another form is to dissolve half an 
ounce of sulphuret of lime in a pint of water, and to add to this two 
drachms of weak chlorohydric or muriatic acid, — the bottle in which the 
mixture is made being allowed to remain open for a few hours in the 
patient's chamber. 

Liquid hydrosulphuric acid may be made by disengaging sulphuretted 
hydrogen from a mixture of one of the sulphurets with dilute sulphuric 
acid, and causing it to pass into water to saturation. This may be 
diluted with four times its weight of water. It has been prescribed 
occasionally as a sedative in pulmonary affections ; but is now rarely or 
never used. 



The last edition of the Pharmacopoeia of the United States had a 
formula for Liquor Ammo'nle Hydrosulpha'tis, Solution of Hydro- 
sulphate of Ammonia, Hydro sulphuret of Ammonia, which was formed 
by passing sulphuretted hydrogen through solution of ammonia. It is 
powerfully sedative, and has been given in diabetes mellitus for the 
purpose of lessening the morbid appetite, so common in that disease; 
but it is now scarcely ever prescribed, and has accordingly been omitted 
in the last edition of the pharmacopoeia. 

15. sedative gases. 

Certain of the gases have been used in the way of inhalation as 
sedative agents, but they are not much employed at the present day. 
Of the effects of one of them — Sulphuretted Hydrogen— -mention 
has just been made. 



GAS ACIDUM CARBONICUM. 201 



a. gas hydrogen'ium. — hy'drogen GAS. 

This gas is procured by the action of dilute sulphuric acid on iron or 
zinc; but as a little acid vapour may possibly be diffused through it, it 
has been esteemed preferable to obtain it, when it is designed to be 
breathed, by passing water in vapour over iron at the temperature of 
ignition. 

Hydrogen gas appears to act altogether negatively, — proving sedative 
in consequence of the absence of oxygen, which is the exciting con- 
stituent of atmospheric air. It can be breathed with safety when diluted 
with an equal portion of air; but, for medicinal purposes, is usually 
mixed with four or five parts. It has been chiefly used in pulmonary 
catarrh, haemoptysis and phthisis. 

6. gas hydrogen'ium carbure'tum. — car'buretted hy'drogen gas. 

Carburetted hydrogen, employed in medicine, is made by passing the 
vapour of water over charcoal at the temperature of ignition in an iron 
tube. The oxygen of the water unites with one part of the charcoal, 
forming carbonic acid ; and the hydrogen combining with another part 
of it forms carburetted hydrogen. The carbonic acid is removed by 
agitating the gas with lime water. 

In its undiluted state, it can scarcely be breathed. Sir Humphry 
Davy found, that at the third respiration total insensibility ensued ; and 
symptoms of great debility continued for a considerable time. 

It was, at one time, thought to be a useful sedative in phthisis, and 
to have arrested the disease in some cases ; but the results w 7 ere by no 
means uniform : caution, too, was needed in its administration, and — 
what is applicable to the inhalation of all gases in pulmonary affections 
— its employment was inconvenient, and often distressing. It has been 
usually diluted with twenty parts of atmospheric air at first, — the pro- 
portion of the gas being slowly increased, and care being taken not to 
induce much vertigo, or muscular debility. 

C. GAS AC^IDUM CARBON'lCUM. — CARBONIC ACID GAs/ 

Carbonic acid gas — procured by the action of dilute sulphuric or 
chlorohydric acid on carbonate of lime ; or, what is preferable, by de- 
composing carbonate of lime by exposing it to a strong heat in an iron 
bottle, and collecting the gas over water, — when undiluted, is altogether 
irrespirable, occasioning a spasmodic closure of the glottis and death; 
but, when diluted with atmospheric air, it appears to possess decidedly 
sedative properties. 

Formerly, it was much employed in phthisis, and great expectations 
were entertained that it might be at least a valuable palliative in that 
disease. It seemed, at times, to lessen expectoration, diminish hectic 
fever, and act as an anodyne. When employed, it was diluted with 



202 REFRIGERANTS. 

four or six parts of atmospheric air. In the irritable state of the bron- 
chial mucous membrane, in which cough and dyspnoea are induced by 
the application of cold, it has been found of advantage when breathed 
in a dilute state. The following has been advised as an easy mode of 
employing it with this view. Put a mixture of chalk or marble with 
dilute sulphuric acid and water into a large glass bottle, so that it shall 
occupy the depth of only a few inches. Carbonic acid gas is extricated, 
and forms an atmosphere mixed with atmospheric air in the upper part 
of the vessel, which may be breathed by introducing a glass tube to 
about the middle of the bottle, and inhaling from it. 

It has been employed externally as a local application to cancerous 
and painful ulcerations. A stream of it is directed on the part, taking 
care that the gas is previously transmitted through water, if it has 
been procured by the action of a mineral acid on carbonate of lime, 
and confining it for some time over the sore by a funnel connected with 
the tube. 

Yeast Calaplasm--CATAPLAs'M\ Fermen'ti of the London and Dub- 
lin Pharmacopoeias — owes its virtues in part to carbonic acid. It is 
generally, however, esteemed as an excitant ; and Dr. Pereira affirms, 
that he has often heard patients complain of the great pain it occasions. 
When applied to fetid ulcers, it corrects the fcetor, and promotes the 
separation of sloughs. It is made of Flour fgj ; Yeast of Beer Oss; a 
gentle heat being applied until the mass begins to swell. 

Of late years, carbonic acid gas has been sent into the vagina in cases 
of amenorrhcea, and in uterine pains, which precede and accompany 
the menstrual discharge ; and it is said with success. The fumigations 
are applied by receiving into the vagina the free extremity of a gum 
elastic canula, surmounted by a nipple-like end, through which the gas 
is passed. The gas is disengaged by means of dilute sulphuric or 
chlorohydric acid poured on carbonate of lime. It does not appear, 
that any excitant effect is induced by the acid vapour that may pass 
over with the gas. Still, to avoid all risk, the gas may be first passed 
through a Woulfe's apparatus, as suggested by an intelligent corres- 
pondent of the author, the late Prof. W. R. Fisher. 



V. REFRIGERANTS. 

Synon. Psyctica, Temperants. 

Definition of refrigerants — Modus operandi — External and internal refrigerants — Refrige- 
rant baths — Therapeutical application of refrigerants — In fevers — In the phlegmasia 
&c. — Special refrigerants. 

Refrigerants maybe defined, — agents that diminish the morbid heat 
of the body. 

The author in another work, {Human Physiology, 6th edit., p. 199, 
Philad. 1846,) has entered at large into the interesting subject of the 
physiology of calorification, and has there attempted to show, that it is 
accomplished in every part of the system of nutrition, — not exclusively 



REFRIGERANTS. *0o 

I 



in the lungs, as was at one time imagined, and still is by many. But, 
althought not effected exclusively in those organs, the experiments of 
Le GaTlois, as well as those since instituted by others, have led to the 
inference, that there is always a general ratio between heat and respira- 
tion in cold-blooded and warm-blooded animals ; and in hibernating 
animals, in the periods of torpidity and of full vital activity. When the 
eighth pair of nerves is cut in the young of the mammalia, a considera- 
ble diminution is produced in the opening of the glottis, so that, in 
puppies recently born, or one or two days old, so little air enters the 
lungs, that when the experiment is made in ordinary circumstances, the 
animal perishes as quickly as if it was entirely deprived of air. It lives 
about half an hour. But, if the same operation be performed on pup- 
pies of the same age, benumbed with cold, they live a whole day. In 
the first case,— M. Edwards thinks, and plausibly,— the small quantity 
of air is inadequate to counteract the effect of the heat ; whilst, in the 
other, it is sufficient to prolong life considerably; and he deduces the 
following practical inferences, applicable to the adult age, and particu- 
larly to man. "A person,"— M. Edwards observes,— 41 is asphyxied 
by an excessive quantity of carbonic acid in the air which he breathes ; 
the beating of the pulse is no longer sensible, the respiratory movements 
are not seen ; his temperature is, however, still elevated. How should 
we act to recall life ? Although the action of the respiratory organs is 
no longer visible, all communication with the air is not cut off. The 
air is in contact with the skin, upon which it exerts a vivifying influ- 
ence ; it is also in contact with the lungs, in which it is renewed by 
the agitation which is constantly taking place in the atmosphere, and by 
the heat of the body, which rarefies it. The heart continues to beat, 
and maintains a certain degree of circulation, although not perceptible 
by the pulse. The temperature of the body is too high to allow the 
feeble respiration to produce upon the system all the effect of which it 
is susceptible. The temperature must then be reduced ; the patient 
must be withdrawn from the deleterious atmosphere ; stripped of his 
clothes, that the air may have a more extended action upon his skin ; 
exposed to the cold, although it be winter, and cold water thrown upon 
his face, until the respiratory movements reappear. ^ This is precisely 
the treatment adopted in practice to revive an individual in a state of 
asphyxia. If, instead of cold, continued warmth were to be applied, 
it would be one of the most effectual means of extinguishing life. This 
consequence, like the former, is confirmed by experience. In sudden 
faintings, when the pulse is weak or imperceptible, the action of the 
respiratory organs diminished, and sensation and voluntary motion sus- 
pended, persons the most ignorant of medicine are aware, that means 
of refrigeration must be employed, such as exposure to air, ventilation, 
and sprinkling with cold water. The efficacy of this plan of treatment 
is explained on the principle before laid down. Likewise, in violent 
attacks of asthma, when the extent of respiration is so reduced that the 
patient experiences suffocation, he courts the cold even in the most 
severe weather ; opens the windows ; breathes a frosty air, and finds 
himself relieved." 

Were the function of calorification wholly accomplished by the lungs. 



204 REFRIGERANTS. 

our refrigerants ought to be applied to these organs to exert their full 
effect ; but, as the evolution of heat takes place in the system of nutri- 
tion of every part of the body, these agents are made to impress only a 
portion of that system, whence the impression is conveyed to every 
part, by virtue of the inthnate sympathy which is known to exist be- 
tween them. To the extent of this sympathy, both in its therapeutical 
and pathological relations, the author has had occasion to allude 
repeatedly. In the healthy state of the frame, it is evinced by the 
morbific influence of cold and moisture, when applied even to a small 
portion of the cutaneous surface, which had been previously shielded 
from their action. If a healthy person expose his feet to these agencies, 
the capillary function becomes modified, and there is not a part of the 
capillary system, which does not feel the effects; but disease is not in- 
duced in the whole, unless the whole is, at the time, predisposed to 
assume the morbid condition. Generally, there is some portion of the 
system of nutrition more disposed at the time to take on diseased action 
than another ; and under the irradiations that occur, owing to the 
modified organic actions in the feet, disease in such portion results. A 
similar action takes place, when we apply cold and moisture therapeu- 
tically, as is done in febrile affections whenever the skin is steadily hot 
and dry. We find it is not necessary, that these agents should be ap- 
plied over the whole of the cutaneous surface, but only over a compa- 
ratively small portion, — as of the hands and arras. The sedative 
influence of the cold is exerted upon the parts with which it is made to 
come in contact ; the function of calorification has its activity dimin- 
ished ; and, soon afterwards, we discover that the heat of the whole 
system has been manifestly lowered by the application. 

The temperature of the human body is rarely raised beyond 106° of 
Fahrenheit's scale. Professor James Gregory, of the University of 
Edinburgh, was wont to say, that he doubted the accuracy of any 
thermometer, when a higher temperature was indicated under the 
tongue or in the axilla. There can be no doubt, that the degree at 
which Fahrenheit has placed fever-heat on his scale, is too elevated. 
There may be cases in which it has reached that point, but the 
ordinary temperature of the blood in fever is far below this. In one 
of the hottest remittent fevers which the author ever attended, it never 
rose higher than 102°, under the tongue. M. Edwards alludes, in his 
work on ; Physical Jigents? to a case of tetanus, communicated to him 
by M. Prevost, of Geneva, in which the temperature rose to 110° 75' 
Fahrenheit. 

It was before remarked, that there is a general ratio between heat and 
respiration ; yet to this there are many exceptions. In the case of a man 
at St. George's Hospital, London, labouring under a lesion of the cervi- 
cal vertebrae, Sir B. Brodie observed the temperature to rise to 111°, at 
a time when the respirations were not more than five or six in a minute; 
and other cases of a like kind are on record. 

To reduce excessive heat, external agents, of a suitable temperature, 
are most effectual. Damp cold, of all external means of refrigeration, 
tends best to diminish the activity with which heat is developed. 
Hence its value as a refrigerant in fevers,— a point now universally 



REFRIGERANTS. 



205 



acknowledged. But if damp cold cannot be sufficiently prolonged, 
sponging with water of any temperature below that of the body 
occasions abundant evaporation, and a salutary refrigeration, the effect 
of which is extended to every part of the frame, in the manner already 
mentioned. 

Cool air is, likewise, a valuable refrigerant ; and its admission in 
febrile affections is generally grateful and salutary. There was a time 
when it was altogether excluded ; when the temperature of the chamber 
was kept elevated, and hot fluids were administered, with the view of 
concocting or maturating some fancied peccant humour, and aiding its 
expulsion from the body. Since the time of Sydenham more, especially, 
these notions have passed away, — although we can yet discover some 
relics of their existence, — and, fortunately for the patient, the instinctive 
desire for cold drinks is now no longer opposed. Indeed the use of cold 
fluids internally, and the free admission of cool air into the apartment, 
when the weather and the feelings of the patient admit of it, may be 
looked upon as amongst the most important and salutary elements in 
our management of febrile cases. 

When the ventilation of an apartment is properly attended to, the 
quantity of febrile heat is diminished, — both by the contact of fresh 
portions of cool air, and by the increased evaporation that necessarily 
ensues. 

When cold fluids are taken into the stomach, they produce an effect 
there, analogous to what occurs when they are brought into contact with 
a portion of the cutaneous surface. They are, indeed, the best internal 
refrigerants; and, of these, cold water — ice cold — and iced lemonade, 
are entitled to the preference. Every one must have observed how 
rapidly and copiously perspiration breaks out over the surface of the 
body, during the heats of summer, after a glass of cold water has been 
taken. This must be owing to the refrigerant influence of the low 
temperature reducing the erethism that exists in the mucous membrane 
of the stomach, as it does in every part of the dermoid surface, when- 
ever the temperature is extremely elevated. By depressing this erethism 
to the healthy standard, the sedative influence is propagated at once to 
every portion of the capillary system ; and the cutaneous transpiration 
is augmented by the diminution of the exalted actions of the cutaneous 
exhalants. This is the only mode in which the phenomenon can be 
rationally explained. It is impossible for us to admit, that the fluid can 
pass so rapidly into the vessels by imbibition as to account for it. The 
perspiration, in such cases, breaks out almost instantaneously after the 
fluid has reached the stomach, and impressed the lining membrane. 

Writers on materia medica have admitted, besides those refrigerants 
to which allusion has been made, a number of agents, whose operation 
is much less unequivocal. *« There are," says a modern writer — Dr. 
Paris—" certain saline substances, which, by undergoing a rapid solu- 
tion, and acquiring an increased capacity for caloric, produce a diminu- 
tion of temperature, and if this takes place in the stomach, the sensation 
of cold, which it produces, is equivalent to a partial abstraction of 
stimulus ; this being extended by sympathy to the heart occasions a 
transient reduction in the force of the circulation, and by this, or by a 



206 REFRIGERANTS. 

similar sympathetic affection, causes a sensation of cold over the whole 
body." It is obvious, however, that such substances, according to this 
theory, can be refrigerant only whilst undergoing rapid solution ; and 
that, therefore, to produce their full effect, they should be given, either 
so as to undergo their solution wholly or partly in the stomach, or im- 
mediately after they are dissolved. Yet how trivial must be the operation 
of cold thus produced, compared with that which can be accomplished 
in fevers by a draught of iced water. And, accordingly, as before re- 
marked, iced drinks may be regarded as amongst the febrifuga magna, 
— the most important refrigerants ; and they are now employed to the 
exclusion of nitrate of potassa, borate of soda, &c, &c, on which re- 
liance was at one time placed. 

There is a circumstance, by the way, connected with the use of these 
refrigerant salts, which is full of interest to the therapeutist, and exhi- 
bits that wandering from the true track, of which philosophy has to 
deplore the existence of so many examples in the history of medical 
science. The author has remarked, that internal refrigerants have been 
made to comprise — in many definitions — saline substances, which, by 
undergoing a rapid solution, produce a diminution "of temperature in the 
stomach or elsewhere ; and the definitions have been so worded, and 
intended, as to include these substances only. Yet, strange to say, the 
attention of the therapeutist has strayed from the circumstances, that 
occasion such substances to be refrigerant ; and we often observe a 
mixture, containing nitrate of potassa in solution, directed to be admin- 
istered at intervals throughout the day. In this mode of administration, 
the whole refrigerant effect, according to the above explanation, must 
necessarily be lost. The mixture must attain the temperature of the 
chamber; and if nitrate of potassa produce any effect, it must be of an 
excitant character. The practitioner, notwithstanding, places great re- 
liance, perhaps, on his febrifuge mixture ; and this at least is fortunate, 
for whilst he is administering it, he is not likely to be officiously irrita- 
ting the intestinal canal by repeated cathartics. In this way, the use of 
an inert and negative compound may be followed by positive advantage. 
Dr. Spillan, however, after citing tbe above observations of the author, 
adds, that " the refrigerant effects of nitrate of potassa, as a sedative, 
when given dissolved in even tepid drinks, such as whey, are known to 
every one." The whole object of the preceding remarks is to show, 
that they certainly are not known to the author; yet he has watched 
most carefully for them : nor have others been more fortunate. Dr. A. 
T. Thomson states, that M the dose of the salt should not be dissolved 
until the instant in which it is to be swallowed ;" and Dr. Pereira accords 
with him ; whilst Dr. Christison, in his ' Dispensatory,' expresses him- 
self in a manner that still more strongly corroborates the views of the 
author. " Its refrigerant action," he remarks, "generally admitted by 
systematic writers on materia medica, and by many practitioners, is of 
doubtful existence, — having probably been inferred rather from the cold- 
ness it occasions while dissolving in water, than from actual evidence 
of its effects in disease. The sedative action ascribed by some to it has 
been probably inferred from its supposed refrigerant property, and not 
from observation." 



THERAPEUTICAL APPLICATION. 207 

In addition to the internal refrigerants, that come under the definition 
of Dr. Paris, certain others have been enumerated, which are presumed 
to exert a temperant effect, — independently of simple abstraction of 
heat. Thus, acetic acid, it is said, when properly diluted, renders the 
pulse, in a febrile state of the habit, slower ; the animal temperature 
less, and improves the secretions. The same has been observed of all 
the vegetable acids, as well as of borate of soda, and boracic acid ; but 
there does not appear to be any strong evidence in favour of their pos- 
sessing this property. Acids and subacids are always grateful in febrile 
affections, and by proving agreeable to the palate they may tend to allay 
irritation; but this applies equally to mineral acids; and, accordingly, 
mineral lemonades are often prescribed beneficially in continental Europe. 
A modern writer, Dr. A. T. Thomson, excludes them, although he 
classes among the refrigerants, — acetic, oxalic, citric, tartaric, and malic 
acids. 

Of borate of soda, and boracic acid, — although the latter was at one 
time termed sal sedativus Hombergi, — it is unnecessary to say much. 
Common consent has led to their total exclusion from the catalogue of 
internal refrigerants in this country and in Great Britain ; although they 
are still prescribed in some parts of Germany, whose pharmacopoeias 
exhibit too many relics of prejudices, and irrational practices, prevalent 
in times that have long passed away. 

Therapeutical application of Refrigerants. 

On the therapeutical application of refrigerants much need not be 
said. They are obviously proper, whenever the vital manifestations 
are exalted beyond the healthy standard: yet they may not all be 
equally appropriate ; and the practitioner has to consider, whether other 
influences may not be exerted by them, independently of mere abstrac- 
tion of heat ; — whether, in other words, their refrigerant operation be 
simple, or combined with some other, that may modify their influence 
on the economy. This is well exemplified in the cases of the cold 
affusion and cold ablution, when employed at the commencement of 

Fevers, with a view of arresting their course. Whilst the former 
may be successful, the latter may totally fail. The object is, here, to 
excite a new impression on the totality of the nervous system, as well 
as to diminish febrile action ; and, accordingly, that form of applying 
the cold medium ought to be selected, which communicates a powerful 
shock, and thus breaks in upon the morbid chain, which constitutes the 
disease. ^ As simple sponging of the hands and arms with cold water 
communicates no such shock, it is manifestly not calculated to cut short 
fever; whilst, on the other hand, the cold affusion becomes inappro- 
priate whenever the morbid phenomena that constitute continued fever 
have persisted so long, that all hope of cutting the disease short has 
vanished; and when any powerful impression is likely to give rise to 
irregularity of action, and, therefore, to hyperemia in some internal 
organ. In these cases it is, that cold, tepid, or even warm ablution is 
employed so advantageously. It tempers the organic actions of the 



208 REFRIGERANTS. 

part to which it is directed, and thence extends its benign influence to 
every part of the organism. 

A practical rule for the use of external and internal refrigerants in 
fever is — to observe, whether the skin be steadily hot and dry. If so, 
cold ablution may be practised ; cool air be admitted ; the quantity of 
bed-clothes be diminished, and cold fluids be freely indulged in ; but 
whether all, or any of these, may be applicable to particular cases has 
to be left altogether to the discrimination of the practitioner. 

In the different stages of the paroxysm of an intermittent, conditions 
are present, that modify materially the employment of agents belonging 
to the class under consideration. In the cold stage, the hot stage, and 
the sweating stage, we are guided by rules, which are applicable to 
similar conditions occurring in other morbid states. In the cold stage, 
the functions are oppressed and depressed ; and there is more or less 
congestion internally : this is dependent upon modified innervation, — 
such modification consisting in diminished action : fluids, therefore, 
which are of a temperature equal to, an'd above, that of the body, are 
needed to excite the nervous and vascular systems to a proper play of 
the functions: as soon as this has been accomplished, and reaction has 
taken place, general excitement is substituted for the previous state of 
diminished action, and all the phenomena of synochal or inflammatory 
fever are present. Cold drinks now become grateful and appropriate; 
they reduce the exalted organic actions and hasten the supervention of 
the sweating stage, during which the heat is undergoing resolution, and 
cold drinks are, consequently, not advisable : tepid drinks are accord- 
ingly substituted. 

That which applies to cold drinks, during the paroxysm of an inter- 
mittent, applies equally to the admission of cool air, and the regulation 
of the coverings of the patient. In the cold stage, warmth is advisable ; 
in the hot, the whole system of refrigeration has to be adopted; whilst, 
in the sweating, care must be taken in the application of cold, lest the 
cutaneous capillaries be morbidly impressed so as to excite irregular 
action in some important part of the organism, and consequent hyperse- 
mic or other mischief. 

Allusion has already been made to the prejudice, at one time univer- 
sal, against the use of cold drinks in fever. This existed as long as, 
and even longer than, the doctrine of concoction, w T hich taught, that a 
certain amount of febrile heat was necessary to maturate the peccant 
matter — the materies morbi. Fortunately for the patient, the prejudice 
is now daily yielding; and w r e rarely meet with it except amongst those 
whose minds have not been enlightened by the more modern, and more 
correct views of therapeutists. The author has likewise referred to a 
similar prejudice, as regards the use of iced drinks, when calomel has 
been given. The prejudice is unfortunate, as it often causes the denial 
of the very best febrifuge we possess ; and suggests an opposite plan 
of treatment, which can scarcely fail to aggravate the disease. Were 
the idea, indeed, well founded, an interesting and important question 
would arise, whether the calomel or the iced water should give place? 
and no doubt, in the author's opinion, ought to exist in the mind of the 
reflecting practitioner, that it should be the former, in most cases. To 



IN INFLAMMATION. 209 

this decision he may be led universally, where calomel is given as a 
simple cathartic. The lists of the materia medica contain such a va- 
riety of those agents, that sufficient room is left for selection. Where, 
also, the mercury is administered as a revellent in fever, or to produce a 
new action in the system, cold water, in moderation, may be permitted 
with impunity, and even with advantage. The author has been, for 
years, in the habit of administering mercurial cathartics, and mercurial 
revellents in febrile and inflammatory affections, and has never wholly 
restricted the patient from the use of ice ; yet, in no case, has he seen 
the slightest inconvenience from the association. The notion of detri- 
ment from this course is now, indeed, abandoned by the intelligent 
physician ; but it still clings with pertinacity to the extra-professional. 

In fevers accompanied with eruptions, the cooling regimen is not less 
important than in the simple continued, and remittent varieties. There 
was a time, when the eruption of small pox and of scarlatina was sup- 
posed to be injuriously checked by the free admission of cool air; but 
it is now acknowledged, that the use of refrigerants is attended with 
better effects than that of any other class of medicinal agents ; and, in 
the generality of cases, the efforts of the judicious physician are con- 
fined to the admission of cool air ; sponging the body with cold or 
tepid water — especially during the eruptive fever, and the use of cold 
water internally ; keeping the alimentary canal clear, at the same time, 
by the employment of gentle cathartics. Allusion has already been 
made to the peculiar character of scarlatina ; and to the fact, that, 
although the organs concerned in calorification are inordinately excited 
— yet, it is an excitement originally more nervous than vascular — and,/w 
that copious blood-letting, instead of mitigating, often adds to, its vio- 
lence. In all cases, however — except, perhaps, in the most malignant 
typhous forms, — the application of cold to the surface, either by means of 
cold water or cool air, or both, maybe had recourse to advantageously. 
Where such agency is improper, the fact will be indicated by the feel- 
ings of the patient. He will be rendered chilly, and the powers of the 
system will be depressed by it ; but there are few cases in which the 
admission of fresh air will not be grateful and salutary. 

Inflammation, and hemorrhage. — It has been conceived that cold 
sponging, and other forms of external refrigerants are not as serviceable, 
where hyperaemia exists in an internal organ, as where the case is un- 
complicated. This is true ; but it by no means follows, that they 
should do harm. In certain internal inflammations, indeed, we are in 
the habit of employing them freely as remedial agents, and the author 
thinks — and it is generally thought — with advantage. In inflammation 
of the encephalon — primary, or occurring in the course of fever — the 
practitioner does not hesitate to have the head shaved, and to apply 
ice freely to it. " In no disease," says Dr. A. T. Thomson, "does 
the powerful sedative influence it possesses display itself so conspicu- 
ously as in phrenitis. The most furious delirium is quickly subdued 
by allowing cold water to drop on the vertex, whilst the rest of the 
scalp is covered with cloths moistened with vinegar and water." Much, 
however, of the effect, in this case is revellent rather than refrigerant. 
The author has before attempted to show, that every form of the cold 
Vol. II.— 14 



210 



REFRIGERANTS. 



douche produces its chief influence by the nervous abstraction it occa- 
sions ; and not only is this the case in the ordinary hyperaBmise of in- 
flammation, but in those of an analogous nature, that accompany hemor- 
rhage. The cold key, applied to the nape of the neck in epistaxis, 
produces its effect in arresting the hemorrhage, less by refrigeration 
than by revulsion. In active hemorrhage, however, the refrigerant 
effect of cold is a most valuable agency ; and, where ice can be pro- 
cured, it may be taken internally, without the inconveniences that result 
from the too free use of cold water. It has been elsewhere remarked, 
that where hemorrhage takes place, absorption is more active ; and, if 
fluid be largely allowed, it soaks readily through the coats of the blood- 
vessels, so that in a short space of time there may be the same quantity 
of blood circulating in the vessels as before the hemorrhagic attack ; 
and as the blood is rendered more watery, a recurrence of the flow fol- 
lows more easily. But, by taking a small piece of ice into the mouth, 
the full refrigerant influence is exerted; whilst there is no danger what- 
ever of much imbibition, and consequent repletion of vessels. 

The utility of cold applications in hemorrhages was referred to under 
Astringents. Whenever, indeed, it is necessary to produce a dimi- 
nution in the amount of fluid in the capillary vessels of a part, their 
employment is indicated ; and hence, in topical inflammations, strangu- 
lated hernia, &c, they are greatly prescribed. In the first of these 
affections, they act much in the same manner as hot applications. Both 
cold and heat, indeed, occasion diminished calibre of the capillary 
vessels. 

Pulmonary diseases. — In diseases of the respiratory organs, which 
interfere with the due aeration of the blood in the lungs, exposure of 
the body to cool air — under precautions to be suggested by the individual 
case — is a useful agent ; and its propriety is indicated by the instinctive 
desire which is felt for the free admission of air under such circum- 
stances. The function of haematosis is not confined to the lungs, 
although chiefly accomplished there. It takes place, but to a slight ex- 
tent only, over the whole cutaneous surface ; and the author has before 
alluded to the marked connexion, that exists between the functions of 
calorification and respiration ; so that if the latter be impeded, it is re- 
quisite that the former should be reduced likewise. 

It is unnecessary to dwell on all the cases in which refrigerants may 
be beneficial. The reflecting practitioner will easily understand those, 
in which they may be demanded ; and, in this, he is fortunately guided, 
in most instances, by the sensations of the patient. Where the ab- 
straction of heat is attended with disagreeable sensations, it can rarely, 
or never, be proper : even in fevers, where the employment of refrige- 
rants is most clearly indicated, we are greatly guided by the feelings of 
the patient; and if the free admission of cool air, cold ablution, and 
cold drinks excite chilliness, or any uncomfortable feeling their appli- 
cation has to be regulated accordingly. 



SPECIAL REFRIGERANTS. 211 



SPECIAL REFRIGERANTS. 

In the preceding remarks, enough has been said of the acidulous and 
other refrigerants that are usually employed in febrile and inflammatory 
affections. It may be proper to add, however, that in these diseases, 
no single refrigerant is more agreeable than the soda or mineral water of 
the shops, kept in ounce vials in ice, and given from time to time when 
the thirst is urgent. In the absence of this, the artificial soda powders 
may be used ; which are made by dissolving in water twenty-five 
grains of tartaric acid, and thirty grains of bicarbonate of soda, adding 
the two together, and drinking the mixture in a state of effervescence : 
— or, what is better, dissolving each of the powders in half a tumbler- 
ful of water, which must be kept cold, and a wine-glassful of each 
solution be taken whilst effervescing, every two or three hours, or oftener. 
In this manner, the stomach is not loaded, nor is the tartrate of soda 
formed in sufficient amount to affect the bowels ; for it must be recol- 
lected, that in the artificial soda water the patient takes a solution of 
that salt in place of carbonated water, which constitutes the soda water 
of the shops. 

Effervescing draughts are likewise made with lemon juice. (Succ. 
limon. f.gss; Sodas carb. gss ; vel Potasses carb. gr. xxv.) The neutral 
or saline mixture, hereafter referred to, (p. 212,) is a composition 
of this kind, given either in effervescence, or after the effervescence 
has passed away. When it is desirable to unite a refrigerant and ca- 
thartic, the Seidlitz powders, described elsewhere, (Vol. i. p. 193,) may 
be given. 

1. Saline Refrigerants. 

Almost all the neutral salts are refrigerant when properly administered • 
but the saline substances that have been regarded as more decidedly so 
are the following, which will not, however, require much consideration 
after the remarks already made in regard to them. 

1. POTAS'SjE nitr as.— nitrate of POTAS'SA. 

The general characters of this salt have been given under the head 
of Diuretics, (Vol i. p. 280,) and its title to be esteemed a refrigerant 
has been canvassed in the general observations on the present class of 
medicines. 

In protracted fevers, it is not unfrequently given in this country, 
associated with tartrate of antimony and potassa, and mild chloride of 
mercury ; (See Vol. i. p. 312,) but it is obvious that in such a combi- 
nation it is impracticable to infer anything positive in regard to the 
action of the nitrate. 

The dose, in which it is usually prescribed, is from five to fifteen 
grains, every three or four hours ; and it is well to bear in mind the 
remark before made, that it ought to be dissolved in water immediately 
before being taken. J 

It is sometimes used as a gargle in inflammatory sore throat, (Potass, 
nitr at. 5iss ; Mel/is 3iij ; Aqux f.|vj ;) and it occasionally forms part 
of frigonfic mixtures, that are applied as topical refrigerants. 



212 SPECIAL REFRIGERANTS. 

Of late it has been given in large doses in acute rheumatism, as it 
had been in the last century by Dr. Brocklesby — a distinguished physi- 
cian of the British army, and medical writer. The testimonies in its 
favour are not few; but it must be borne in mind, that the disease is 
self-limited in many instances, — in other words, appears to run a defi- 
nite course greatly uninfluenced by medicine. From six drachms to two 
ounces have been given in the twenty-four hours dissolved in sweet- 
ened barley water, in the proportion of half an ounce of the nitrate to 
a pint and a half or two pints of the barley water. It is said, under 
such circumstances, to act as a sedative, decreasing the force and fre- 
quency of the pulse, perhaps indirectly by its revulsive action on the 
stomach ; but farther observations are needed to establish its efficacy, 
before we attempt to explain the modus operandi. 

The last Edinburgh Pharmacopoeia contained a formula for Troches 
of Nitrate of Potassa, composed of one part of nitrate to three parts 
of sugar ; which were used in inflammatory sore throat, and in exces- 
sive ptyalism ; but they do not exist in the present pharmacopoeia. 

The Germans, according to Sir George Lefevre, consider nitrate of 
soda more antiphlogistic than nitrate of potassa. 

2. POTAS'S^E CITRAS.— CITRATE OF POTAS'SA. 

Citrate of potassa is never kept in the shops. It is readily made by 
saturating the potassa of carbonate of -potassa with citric acid; but the 
salt is deliquescent, and crystallizes with difficulty. A solution of it is 
very frequently formed extemporaneously ; and the Pharmacopoeia of 
the United States of 1842, contains two formulae for the 

LIQUOR POTASSiE CITRA'TIS, SOLUTION OF CITRATE OF POTAS'SA; the one 
made with fresh lemon-juice, and the other with citric acid. (Succ. 
limon. recent. Oss ; Potassx carbonat. q. s. ; — or, Acid, citric. 3ss ; 01. 
limon. *lij ; Jtqux Oss ; Potassx carbonat. q. s.) 

These formulae are properly, perhaps, introduced, seeing that the 
mixture is so often prescribed, in order that uniformity may be observed 
in its preparation. It is the well known ' neutral mixture? which, in 
one form or other, has been employed in febrile cases for ages. When 
accurately prepared, it is merely a solution of neutral citrate of potassa 
flavoured with lemon-peel ; and has no more diaphoretic virtue than a 
similar solution of any of the neutral salts. Yet it is constantly admin- 
istered in febrile cases ; and as these generally do well under the 
observance of a course, which avoids all unnecessary irritation, and re- 
moves, as far as possible, disturbing influences when they occur, a por- 
tion of the good effects is very apt to be ascribed to any agent which is 
administered at the same time. The neutral mixture, saline mixture — 
as it has been likewise called — has been extensively used by the author; 
but he has long abandoned its employment, except where it was neces- 
sary to carry out a temporizing method of treatment ; and in these very 
cases, it is much preferable to give the mixture in a state of efferves- 
cence, in order that the gently excitant influence of the carbonic acid 
may be exerted on the stomach. Still, for this purpose, the use of the 



SODJE BORAS. 213 

mineral water or soda water of the shops is to be preferred. When 
kept cold — ice cold — it is an admirable refrigerant, and exceedingly 
grateful, much more so than the neutral mixture, no matter how well 
the latter may be prepared. 

3. SODjE boras.— borate of soda. 

Borax, — Biborate, Borate, or Subborate of Soda, is probably no more 
entitled to the reputation of a refrigerant than nitrate of potassa. It is an 
abundant natural production in Persia, and especially in Thibet, being 
contained in the waters of various lakes, on the borders of which it is 
left during the dry season in impure crystals. In this state it is called in 
commerce Tincal or Crude Borax, and is usually imported from Cal- 
cutta. It is in flattened, six-sided prisms, coloured with a greasy sub- 
stance which has been considered by M. Vauquelin to be a fatty matter 
saponified by soda. Different methods have been recommended for 
purifying it. At one time, the purification of it was altogether in the 
hands of the Dutch, and was kept a profound secret; but in 1818, MM. 
Robiquet and Marchand made known the process, which is now gene- 
rally followed by manufacturers. It consists in rinsing tincal in lime 
water, so as to decompose the alkaline soap on its surface, and convert 
it into an insoluble calcareous soap,— dissolving the salt in water, and 
decomposing any remains of the alkaline soap in the solution by a little 
muriate of lime, — finally evaporating and crystallizing by very slow 
cooling. (Christison.) This is refined borax. 

A great part of the refined borax of commerce is now made by the 
direct combination of boracic acid with soda. The boracic acid is an 
abundant natural production of certain lagoons and hot springs in Tus- 
cany ; and the mode of separating it is described at length by Dr. 
Pereira. The manufacture is now so extensive, that one single indi- 
vidual is said to fabricate the enormous quantity of 2,400,000 pounds 
annually, for the supply of most parts of Europe and America. (Buch- 
ner, cited by Christison.) 

Borate of soda of the shops is in large crystals, which are oblique 
rhombic prisms. It occurs, also, in octohedrons, but is generally seen 
in irregular shaped masses, of a saline, cooling and somewhat alkaline 
taste. It effloresces slowly in the air, and is wholly soluble in water, 
the solution having an alkaline reaction. It requires twelve parts of 
cold water, and two of hot to dissolve it. When added to bitartrate of 
potassa, it renders the latter soluble — forming soluble cream of tartar. 
This may be effected by boiling six parts of cream of tartar and two of 
borax in sixteen of water for five minutes. 

Borax has generally been considered refrigerant, yet this has been 
probably owing to the cooling taste of the salt rather than to correct 
observation of its effects : when used locally, it is admitted to be a mild 
excitant, causing smarting when applied to sores. It is never given 
internally in this country as a refrigerant, but is often employed in cases 
of stomatitis,— particularly of the follicular form ; and has been occa- 
sionally used as an injection in gonorrhoea and leucorrhoea. In these 
cases it probably acts as a gentle excitant. As a gargle, it is often used 



214 SPECIAL REFRIGERANTS. 

in association with honey, (Soda borat. 3i ; Mellis 5iij ; Jiquce f.^vj,) 
in sore throat, and pytalism. 

HONEY OF BORAX, MEL BORA'CIS, is officinal in the British pharmaco- 
poeias, (Sodas borat. 5i ; Mellis ^i.) It is used in aphthous affections 
of children ; and, dissolved in water, in stomatitis and cynanche. 

Boracic Acid — formerly termed Sal Sedativus Hombergi — is never 
used, at the present day, as a sedative. It is nearly, if not wholly inert. 
It has been given in very large doses without producing any sensible 
effect on the functions. 

2. Topical Refrigerants. 

In another part of this work, (Vol. i. 505,) as well as elsewhere, 
(Human Health, p. 364,) the author has alluded to the marked difference 
— and this ought never to be lost sight of — between the effects of a bath 
some degrees lower than the temperature of the body, and those of one 
that approaches or exceeds it. Whilst the former is markedly refrigerant, 
the other is powerfully excitant. The two are adapted, consequently, 
for very opposite affections. 

A difference, again, exists, between immersion, affusion, and ablu- 
tion, — the former being attended with a shock or powerful impression 
on the nervous system. When, therefore, the object is to diminish 
febrile heat, — ablution or sponging a part of the capillary surface, as of 
the upper or lower extremities, is preferred to general baths, and to 
affusion, — as the shower-bath, or any variety of the douche; but if the 
object be to excite a revulsive effect, — to break in upon a morbid chain, 
as to cut short a fever, — then the form of application is chosen which 
produces the greatest shock, or, in other words, the most powerful im- 
pression upon the nervous system. The shower-bath is well adapted 
for such cases; it acts, in the main, like the ordinary bath, as regards 
temperature, producing sedative effects, when cold ; stimulating when 
hot. Owing, however, to the shock produced by it, it is not suitable 
for those of great nervous susceptibility. For such as are predisposed 
to certain head affections, the shock and refrigeration of the cold 
shower bath applied directly to the head, whilst derivatives are applied 
to the lower extremities, often proves most salutary. The effects of the 
douche or dash are dependent mainly on the shock; but partly, also, on 
the temperature of the fluid. They are, however, modified by the size 
of the stream, and the force with which it is made to impinge on the 
part. It is a valuable tamer of the furious maniac. The most violent 
paroxysm can generally be speedily brought to a close by it; and the 
impression made upon the nervous system is so overwhelming, that 
tranquillity succeeds rapidly to the state of cerebral excitement and 
turmoil. It is proper to remark, however, that even the cold affusion 
is highly recommended by Professor Dickson, — now of New York, 
formerly of Charleston, — in remittent fever. " The particular indica- 
tions—he says — which demand the resort td it unhesitatingly, are 
found in the youth and general vigour of the patient, and the heat 



TOPICAL REFRIGERANTS. 



215 



and dryness of the surface. The local determination, which it con- 
trols most promptly, is that of the brain, shown by headache, flushed 
face, red eye, delirium, &c, with a full, hard, bounding pulse. Seat 
your patient in a convenient receptacle, and pour over his head and 
naked body, from some elevation, a large stream of cold water ; con- 
tinue this until he is pale or his pulse loses its fullness, or his skin 
becomes corrugated, and he shivers. On being dried and replaced in 
bed, a genial sense of comfort and refreshment will attest the benefits 
derived from the process, which, as I said above, may be repeated 
whenever the symptoms are renewed, which it is so well adapted to 
remove." In yellow fever he greatly prefers the cold bath to the 
lancet. <c If I do not deceive myself" — he remarks — "it is equally 
effectual in subduing morbid excitement, and controlling irritation, 
without any positive expenditure of, or subtraction from, the vital 
forces;" — and he adds, that he has never seen any unpleasant conse- 
quences from it. The contraindications to its use are great age and 
debility, and " the rather unfrequent determination to the lungs and 
bowels shown by dyspnoea and diarrhoea." Should it produce pro- 
tracted chilliness or other discomfort, he, of course, does not repeat it. 

In an ordinary case of hysteria or in cerebral affections for which a 
small stream of water is sufficient, the douche may be formed from the 
spout of a tea-pot held at such a distance above the 
head as to regulate the force with which the water 
is made to impinge upon it. 

An excellent shower-bath for children — which 
may be used also by the adult — has been invented, 
and is described by Dr. A. T. Thomson. It consists 
of a hollow vessel made of tin with a perforated 
bottom, as in Fig. 157. 

The body of the vessel is of a bell-shape a, with 
a hollow tube 6, Fig. 158, rising from the top, and perforated tottom of shower-bath. 
terminating in a broad perforated rim c. When the bath is to be used, 
it must be sunk in a bucket of water, 
until it is completely submersed ; the air 
is thus driven out of the bath, through 
the tube b c, and the bath filled with 
water. The thumb of an attendant is 
then to be placed on the opening in the 
centre of the rim c, and the bath is raised 
from the bucket of water. The pressure 
of the air on the holes in the bottom re- 
tains the water in the bath ; and on raising 
the thumb from the upper orifice, the 
whole is rapidly discharged. In using 
it, the child must be placed in an empty- 
tub, and the bath, being held over his 
head, is then to be discharged. Imme- 
diately afterwards he must be dried with 
friction. 

Almost the only form of bath now em- 




Fig. 158. 




,!!l|!l'i!;iii!lS^ 

i;!.;i' ; :i:Mlr ;l iiii 1 i!!'V,i;:i:M , 1 ;i;i!'.l 

1 '•'ji''.!' i'l J i "' 



Shower-bath for children. 



216 SPECIAL REFRIGERANTS. 

ployed in febrile case is simple ablution, and the warm pediluvium or 
foot-bath. It might seem that, in these very cases, a more powerful 
refrigerant influence would be exerted by the cold pediluvium ; and, as 
regards the mere abstraction of caloric, this would, doubtless, be the 
case ; but the shock or impression made upon the nervous system is so 
powerful, when we first immerse our feet in a cold fluid, that the cold 
pediluvium becomes liable to the same objections as the cold affusion 
or the cold douche, when employed with simple refrigerant views. On 
the other hand, the warm pediluvium is devoid of those objections; 
whilst the ultimate refrigerant effects are scarcely perhaps less. 

After the remarks already made, it is unnecessary to dwell on the 
topical use of cold applied to the surface of the body. It is the abstrac- 
tion of caloric, which is the main agency ; and the degree to which 
this shall be carried must depend upon the particular case. It may 
be proper to add here, that where the local abstraction- of heat is de- 
manded, and ice cannot be had, it becomes important to apply sub- 
stances — as to the head in cases of encephalitis — which by their 
evaporation may induce cold: hence, ether and alcohol are employed; 
and, in ordinary practice, cloths steeped in whisky, which are changed 
when they become warm. A common mixture for the purpose consists 
of equal parts of Whisky, Liquor Ammonia Acetatis, and Water ; but 
it possesses no virtues over simple whisky. 

In the application of topical refrigerants, the part should be covered 
with a single layer of thin linen or cotton or muslin, which should 
be frequently wetted with the cold fluid ; or a sponge, holding it, 
should be squeezed over the rag, without removing it from the head. 
Dr. James Arnott has recommended what he esteems to be a per- 
fect mode of applying cold. He covers the part with a very thin 
bladder of the requisite dimensions, containing a small quantity of 
water of the desired temperature, which is constantly renewed by 
establishing a current through the bladder, by means of two pewter 
tubes, — one connected with a reservoir, and having a stopcock at its 
end to regulate the stream, — the other leading to a waste vessel. The 
elevation of the waste-pipe regulates the quantity of water in the 
bladder ; and as, from the change of position of the patient, this ele- 
vation must be frequently altered, it is convenient to rest the extremity 
of the pipe on a sliding ring of a common retort stand. By this appa- 
ratus, he says, the temperature can be regulated with the greatest pre- 
cision, and with such a test as a guide, water can be chosen of the 
temperature that may be most agreeable to the feelings of the patient. 
If sudden and severe cold be desirable, very cold water passed rapidly 
through the bladder will reduce the temperature more speedily than 
the application of ice. And where great cold is required in the 
absence of ice, or where the temperature of 32° is not sufficiently 
depressed, frigorific mixtures may be substituted, of which the fol- 
lowing are amongst the most available : 

1. Ammon. muriat. ; Potasses nitrat. aa p. v.; Aquce part. xvj. 
This depresses the temperature from 50° to 10°. 



REVELLENTS. 217 

2. Amman . muriat. ; Potasses nitrat. aa p. v. ; Sodae sulphat. p. 
viij. ; Aqua p. xvj. Depresses from 50° to' 4°. 

3. Jimmon. nitrat. ; Aqua aa p. j. Depresses from 50° to 4°. 

4. Jimmon. nitrat. ; Soda carbon.; Aqua aa p. j. Depresses from 
50° to 7°. 

5. Sodas sulphat. p. iij. ; Acid, nitric, dilut. p. ij. Depresses from 
50° to 3°. 

6. Sodas phosphat. p. ix. ; Acid, nitric, dilut. p. iv. Depresses 
from 50° to 12°. 

7. Sodas sulphat. p. viij. ; Acid, chlorohydric. p. v. Depresses 
from 50° to 0°. 

8. Soda sulphat. p. v.; Acid, sulphur. ; Aqua aa p. ij. Depresses 
from 50° to 3°. 



VI. REVEL'LENTS. 

Synon. Antispastics, Derivatives, Counter-irritants, Revulsives. 

Definition of Revellents — Epispastics — Definition of Epispastics — Rubefacients — Vesicants 
— Suppurants — Actual and Potential Cauterants — Modus Operandi — Fermanent and 
Intermittent Revulsions — Intensity of the Revulsion — Blisters, as Revellents in Fever — 
Revulsion in the Changeable Phlegmasia — Choice of Situation for the Revulsion — 
Therapeutical Application of Revellents — In Fevers — In the Phlegmasia? — In Hemor- 
rhage — In Mental Alienation, Hysteria, Tetanus, &c. — Special Revellents. 

Revellents are agents, which, by producing modified action in 
some organ or texture, derive from ijie morbid condition of another 
organ or texture. The effect, thus induced, is termed revulsion, anti- 
spasis, or derivation, and it is said, by Conradi, to be exerted, " when 
a topical congestion, or stimulation, or other affection of a part leaves 
that part, and is drawn towards another, and usually less important 
part." 

The author has more than once referred to the value of this agency 
in the treatment of disease ; and has remarked, that much of the good 
effects produced by local stimulants, of every kind, is ascribable to this 
principle of action. The effect, indeed, of almost every variety of re- 
yellent, is ascribable to the exaltation of vital manifestation it produces 
in the parts with which it is made to come in contact. "Next to direct 
debilitation," says a modern therapeutical writer — M. Begin — "there 
is no medicinal agency more certain, and that ought to be more fre- 
quently resorted to, than revulsion. It is induced by stimulating sub- 
stances, which elevate the organic actions in the parts to which they are 
applied, or towards which their action is directed, and that are more or 
less remote from the inflamed organs. The remedies, employed in this 
medication, have been called, by some, l indirect debilitants ;' but such 
a denomination is inexact, for all revulsives exert a stimulating impres- 
sion ; and if their object be to allay irritations existing at a distance, 
their inopportune use, or their too great activity is followed, in many 
cases, by contrary results :" — and he adds in a subsequent page — " The 



218 REVELLENTS. 

phenomenon of revulsion has hitherto been viewed in too limited a 
manner. Physicians have not properly attended to the fact, that every 
medicinal operation by means of which the vital actions are excited in 
others than the parts affected, also belongs to the class. It would 
seem, that the rubefacient, suppurative, or escharotic, cutaneous revel- 
lents have alone occupied the attention of practitioners, and that fric- 
tions, baths, cataplasms, — in a word, all agents, calculated to solicit 
organic activity concentrated internally to the external parts of the 
body, are not esteemed revulsives ; and reciprocally, the effects of a 
multitude of stimulants on the digestive organs, heaped in during the 
most serious acute diseases, and whose impression is not always mortal, 
are inexplicable to a great number of physicians, because they do not 
recognize in them the revulsive effect, which such agents occasionally 
produce. This medication, when properly investigated, ought to be- 
come the object of more extensive and useful considerations in practice, 
until the whole extent of its influence, and the astonishing variety of 
which it is susceptible in its applications, shall be better understood." 
Under the history of the separate divisions of remedial agents, already 
considered, the author has adverted to their revulsive operation ; and 
it has been seen, that all local stimulants are possessed of more or less. 
It will, therefore, be only necessary, under this head; to make some 
general observations on their application in disease, and to describe 
especially those agents that are usually employed as cutaneous revel- 
lents ; or, in other words, that are generally classed by therapeutical 
writers under the head of epispastics and escharotics, whenever the 
latter are employed to do more than act chemically on the parts with 
which they come in contact, and to affect organs or tissues, that are at 
a greater or less distance from the seat of their impression. 

Epispastics occasion inflammation, vesication, suppuration, or slough- 
ing when applied to the cutaneous surface. Dr. A. T. Thomson has 
subdivided them into rubefacients, vesicants, suppurants, and actual 
cauterants. To these, his division of escharotics may be appropriately 
added; for although the articles belonging to this division are generally 
employed for mere local action on the part with which they are placed 
in contact, they, like the rest of the class of epispastics, are often used 
for acting revulsively on other parts of the system. 

Rubefacients, as the name imports, are substances that redden the 
surface, by exciting the action of the capillaries, and giving occasion-to 
an afflux of vascular and nervous power to the part on which they are 
applied ; hence pain is a usual consequence of their employment. The 
most common rubefacient, in acute affections more especially, is the 
sinapism or mustard cataplasm ; but every stimulating application,— 
every liniment, of which capsicum, turpentine, ammonia, &c, form the 
basis, — is rubefacient. The same may be said of friction with the dry 
hand, and of the application of heat. Everything, in short, which, by 
irritating the cutaneous surface, attracts the nervous and vascular in- 
fluxes to the irritated part, and reddens it, is a rubefacient. 



RUBEFACIENTS. 219 

If the rubefacient be sufficiently powerful, it may, besides inducing 
redness, be followed by an effusion of serum beneath the cuticle, so as 
to form a blister. The rubefacient then becomes a Vesicant. The 
first effect of ordinary vesicants is to produce rubefaction ; and the 
action may be arrested at this point, if the practitioner be desirous that 
it should not extend farther. It may be laid down as a general rule, 
that blisters do not act by the discharge they excite : their depleting 
effect, in this way, can obviously be but trifling, unless in very debili- 
tated states of the system, — and in such case, the loss of fluid, thus in- 
curred, might be disadvantageous. Counter-irritation is the great 
sanative agency ; and this can be obtained without vesication, although 
the production of the latter condition may be an evidence, that the 
former has been carried to the necessary extent. In the case of many 
of the vesicants, too, it is difficult to obtain the requisite amount of 
counter-irritation without vesication resulting at the same time ; and 
therefore the practitioner rarely attempts to arrest their action at simple 
rubefaction. 

Of the various agents, used for exciting vesication, cantharides are 
the chief; but where it is desired to excite sudden vesication, the ap- 
plication of boiling water, or of the red hot iron, is, at times, had 
recourse to. Vesication or counter-irritation, thus induced, is rarely, 
however, as efficacious in changing certain morbid conditions as where 
it is more general. Hence, time has been regarded, in many cases, as a 
useful element, in the action of revellents. 

The inflammation of the skin, caused by vesicants, is occasionally 
attended with fatal consequences. It is of the erysipelatous kind, and, 
under particular circumstances — as regards age, condition of the system, 
&c. — the inflammation eventuates in gangrene and death. In very 
young children, great irritation is apt to be induced by blisters, and, if 
they be labouring under any morbid condition of the dermoid tissues, — , 
such, for example, as is present in measles or scarlatina, — the inflam- 
mation may terminate in sloughing or gangrene. To obviate this, when 
vesicants are esteemed necessary in the diseases of infants, they should 
not be permitted to remain too long on the part. From two to six 
hours will generally be sufficient ; and a piece of fine gauze or tissue 
paper may be placed between the plaster and the skin, if cantharides 
be used, in order that no particle of the flies may adhere to the vesi- 
cated surface. An occurrence more disagreeable to the philanthropist 
can hardly be imagined, than that of a patient dying in consequence of 
the application of an agent from which he expects a cure, or at least a 
mitigation of the symptoms; great caution is therefore necessary in the 
use of these agents in very early life, especially in the diseases referred 
to. The author has known several cases of death manifestly caused by 
the use of blisters under such circumstances, although it is probable, 
that in most of them a fatal event might have ultimately resulted from 
the disorganization produced by the mischief for which the blister was 
recommended. Many fatal events have been referred to by Professor 
J. B. Beck, in his recent " Essays on Infant Therapeutics" (New 
York, 1849). The result has produced, at times, so powerful an im- 



220 * REVELLENTS. 

pression on the mind of the practitioner as to prevent him from ever 
afterwards applying blisters in the diseases of childhood. 

There is another inconvenience attendant upon the employment of 
vesicants composed of cantharides, — the absorption of the cantharidin, 
which enters the circulation, and proceeds to the urinary organs, giving 
rise to strangury, and, at times, to intense vesical irritation. That this 
is the mode in which the effect is induced is demonstrated by the fact, 
that the intervention of tissue paper, or of gauze, although it may not 
prevent vesication, effectually obviates strangury ; — the tissue paper or 
gauze preventing the absorption of the cantharides. Some have re- 
ferred the strangury from blisters to sympathy. Were this explanation 
correct, the tissue paper or gauze ought not to prevent it, as vesication 
is accomplished through them. At times, it becomes necessary to apply 
the blistering plaster over a surface, which has been scarified in the 
the operation of cupping, or over leech-bites. The only precaution, 
here requisite, is to cover the wounds, made by the scarificator, with 
tissue paper. 

Suppurants produce a deeper degree of inflammation than the epis- 
pastics mentioned thus far. Their effect extends to the cellular mem- 
brane, involving the whole of the common integuments. Issues and 
setons belong to this class, as well as the pustulation induced by fric- 
tion with the ointment of tartrate of antimony and potassa rubbed upon 
a part — a remedy which has been much employed of late years. It is 
a somewhat singular circumstance, that when this ointment is rubbed 
upon the skin, instead of its producing simple inflammation of a diffusive 
or erysipelatous character, it should excite inflammatory irritation, more 
especially in the areolar membrane beneath; and that this irritation 
should exhibit itself in the form of a crop of pustules, not very much 
unlike those of variola. 

In this country, issues and setons are still greatly used, but they are 
by no means as much so in Europe as they were formerly. They are 
uncleanly by reason of the discharge they excite, and great attention to 
(V- them is necessary ; whilst it is extremely doubtful, whether any of the 
benefit derived from them is ascribable to the discharge that accompa- 
nies them. On these accounts the author rarely has recourse to them, 
preferring repeated blisters, and a succession of revulsions, to a more 
permanent irritation : to this latter the system soon accommodates itself, 
so that, after an issue or seton has been long established, it becomes, 
as it were, a part of the healthy condition ; and cannot even be healed 
without danger of evil consequences. At one time, it w r as the universal 
belief — much encouraged by the arguments of Mr. Pott — that the dis- 
charge is an important adjuvant to the counter-irritation caused by 
issues or setons; but, since his time, the belief has gradually faded 
away, and there have been many surgeons — amongst whom may be 
mentioned Baron Larrey — who think it better to produce counter-irrita- 
tion, without discharge ; hence, when they use moxa, for example, they 
endeavour to restrict its effects to rubefaction. Still, there are cases — 
as in spinal disease — where it is easier to insert a seton, or to establish 
an issue, than to apply a succession of other counter-irritants ; and, con- 



ACTUAL CAUTERANTS. 221 

sequently, issues and setons are no where banished from practice ; 
although they are more sparingly used by the most distinguished prac- 
titioners in many countries. 

In the perpetual blister — as it is called — we have an example of a 
protracted suppurant agency. An irritating salve is applied to the sur- 
face denuded by a blister, which excites suppurative inflammation ; and 
this may be kept up, as in the ordinary issue, of which the perpetual 
blister is of course a variety, — but it is liable to the same objections as 
the issue, and may be advantageously replaced by repeated blisters, 
which establish a succession of centres of fluxion or of revulsion, so 
that the system never becomes habituated to them ; and more influence 
is, therefore, exerted upon the morbid condition for the removal of 
which they were employed. 

It is to substances, that are capable of producing an eschar or slough, 
that the term Escharotics has been given. They are, consequently, 
most commonly had recourse to for the formation of issues, the escha- 
rotic being applied to the skin, so as to chemically disorganize it, or 
destroy its vitality ; after which a new action is set up in the vessels 
beneath the slough, so as to cause it to be thrown off; the excavation 
is then kept open by inserting some irritant — as an issue pea — which 
maintains a copious secretion of pus from the ulcerated surface. In the 
ordinary division of escharotics, as adopted in the books, a separation 
is made into those which operate more powerfully, destroying the life of 
the part under all circumstances, and which are arranged under the 
head of cauterants ; and those that act with less energy, and are chiefly 
employed to destroy diseased and fungous growths, and which are 
classed as erodents. 

Cauterants may be either actual or potential ; that is, they may either 
produce their effect by the agency of caloric, or by virtue of chemical 
powers, which are capable of destroying, or disorganizing, the living 
solid. The effect of the actual cauterant differs according to the form 
in which the caloric is applied — for example, by means of heated metal, 
or the moxa, or by heated vapour, water, or other fluid. It differs, also, 
when the metal is used, according to the degree of heat : — at the white 
heat producing immediate disorganization of the parts with which it 
comes in contact; and at the red heat, a state which may admit of the 
parts being restored, without much, if any loss of substance. The less 
degree of heat is, therefore, attended with more pain and inflammation ; 
because the vitality of the part is not extinguished. 

Whenever actual cauterants are employed as counter-irritants, the 
excitement they occasion is rapidly effected ;— at once, by the applica- 
tion of heated metal or water, — more gradually, by the moxa ; but 
still, even in the latter case, almost instantaneously, compared with the 
action of many of the class of potential cauterants, which require a 
long time before the eschar is formed. This is the case with caustic 
potassa, — the potential cauterant most frequently employed. It is not 
until after the lapse of several days, that the eschar made by rubbing 
potassa over the skin separates, or gives unequivocal evidence of disor- 
ganization. As the effects of actual cauterants are rapid and severe, — 



222 REVELLENTS, 

accompanied with intense pain, heat and redness, — they are adapted 
for cases, in which it is necessary to make, at once, a powerful impres- 
sion upon the nervous system. Accordingly, the use of moxa has occa- 
sioned a salutary abstraction of the nervous influence ; and many deep- 
seated pains have yielded to it, which had resisted the action of the 
ordinary counter-irritants, although repeatedly applied. In long con- 
tinued neuralgic pains, whether seated in the cerebro-spinal centres, or 
in the nerves emanating from them, the morbid catenation is often 
suddenly and effectually broken in upon by severe and rapid revul- 
sions. 

Of the value of moxa, as a therapeutical agent, in these and similar 
cases, numerous examples are recorded on the authority of Baron 
Larrey, and of many other practitioners of France and, the continent of 
Europe more especially. The remedy was introduced to the notice of 
British practitioners by the author, in the first English monograph on 
the subject ; and, since then, it has been treated by Messrs. Wallace, 
Boyle, and others. (" On the use of the moxa as a therapeutical agent ; 
from the French of Baron Larrey, with notes, and an introduction, con- 
taining the history of the substance," by Robley Dunglison, etc., etc. 
London, 1822.) 

All the forms, then, of epispastics are indebted, for their efficacy as 
remedial agents, mainly to the counter-irritation or revulsion which they 
effect ; and the choice of such as are adapted to particular circumstances 
of disease must greatly depend upon convenience, &c, of application, 
which certain articles of the class may possess more than others ; and 
as there are generally fewer objections to vesicants and rubefacients 
than to the others, they are more frequently employed, whenever the 
revulsion, which epispastics in general are capable of effecting, is 
deemed necessary or expedient. 

In the employment of revulsives in general, it is an interesting 
inquiry to determine the extent of surface, which it is desirable to 
affect by their direct application. This is a difficult matter to decide. 
It is obvious, however, that if we have the vital manifestations modi- 
fied over a very limited compass, but little beneficial agency may be 
exerted on the morbid catenation, which it is designed to break up: 
whilst, on the other hand, if a large surface be irritated, the disease 
may be aggravated by the irritative irradiations proceeding from it. 
Moreover, it is probable, that if an extensive surface were inflamed in 
this manner, the same disastrous consequences might ensue as in cases 
of extensive burns. In these, it has been considered, that death will 
almost surely occur, if they implicate one-eighth part of the cutaneous 
surface. M. Begin affirms, that the extent of the surfaces, receiving 
the impression destined to become revulsive, exerts great influence. 
Thus, the same pediluvium, which proves inefficacious when applied 
to the feet, may often produce the desired effect if the whole leg be 
immersed ; and he adds, that an extensive though moderate rubefaction 
may produce greater effects than a violent inflammation limited to a 
small portion of integuments. This is true, however, only within cer- 



PERMANENT AND INTERMITTENT REVULSIONS. 223 

lain limits. In many affections, as the author has remarked in reference 
to moxa especially, a violent degree of irritation, excited over a very 
trifling extent of surface, may affect what other varieties of epispastics, 
although repeatedly employed, have totally failed to accomplish. Cus- 
tom has established a magnitude for the ordinary blister, as well as for 
the extent of surface to be implicated in the formation of an issue; and 
although it is possible and probable, that the size might often be varied 
with advantage, it is a point, as already observed, on which it is 
extremely difficult to decide. 

A similar remark applies to the length of time, during which counter- 
irritation should be maintained, in order to produce the greatest amount 
of benefit: — whether, for example, a mere momentary irritation, how- 
ever violent, can occasion as salutary results as one that is more pro- 
longed ; and again, whether a permanent or an intermittent revulsion is, 
as a general rule, more effective for the removal of disease, especially 
of disease of any continuance. In the case of moxa, the revulsion is 
temporary ; yet, we have seen, it has been often useful. The revulsion 
from moxa is not, however, in general, as well adapted for the removal 
of inflammatory and many other morbid conditions, as that which can 
be effected by vesicants, and by certain of the rubefacients. It is 
chiefly when the diseased action has been prolonged for a considerable 
period, and in affections, which belong to the neuralgic class, that 
sudden and violent revulsions are productive of .the most marked 
advantage. When diseases are of an acute character — as the different 
phlegmasiae — revellents, which implicate a greater extent of surface, 
and are more prolonged in their action, are decidedly preferable. 

In answering the question, whether a permanent or an intermittent 
revulsion be more efficacious ? — the author does not think, that much 
difference now exists amongst therapeutists. The majority are unequi- 
vocally in favour of the latter plan, although circumstances may often 
induce them, in practice, to have recourse to the former. The reasons, 
in favour of this preference, are cogent. When an artificial irritation, 
accompanied or not by increased secretion from the part, has been 
established for a time, it ceases, in a great measure, to be a morbid con- 
dition, and becomes, as it were, a part of the healthy function ; so that 
it cannot be arrested without inconvenience being apt to result, and 
without danger of a centre of fluxion being established in some internal 
organ, that may at the time be more disposed than others to assume the 
morbid condition. In this way, many discharges, the result of morbid 
action, may become, at length healthy ; and cannot be officiously inter- 
fered with. On the other hand, if a succession of irritations be pro- 
duced, the system never becomes habituated to them ; and the 
repetition of the irritation, after the lapse of a short period, occasions 
the same beneficial impression, as on its first employment. Hence it is, 
that a succession of vesicants, and, indeed, of every variety of epis- 
pastic, is to be preferred to a more permanent application ; and that 
issues and setons lose much of their beneficial influence in the latter 
periods of their employment, their good effects, as revellents, being in 
an inverse ratio with the shortness of the period, during which they have 
been in action. 



224 REVELLENTS. 

The intensity of the artificial irritation induced by a revellent is 
worthy of consideration in a therapeutical point of view. If it be but 
trifling, it may be insufficient to break in upon the internal morbid ca- 
tenation ; and, on the other hand, if too violent, irritative irradiations 
may proceed in various directions, and even add to the internal mis- 
chief. Every practitioner must have occasionally witnessed an aggrava- 
tion of symptoms from this cause, especially in those whose nerves are 
unusually impressible. In such, no variety of epispastic can, at times, 
be used. There are some who are thrown into the most violent nervous 
agitation by the application of the smallest blister ; and blisters have 
occasionally been known to induce convulsions. Certain individuals, 
too, suffer excessively from the vesication caused by cantharides, and, 
yet, they may not be — what would be called — extremely nervous. Their 
cutaneous nerves are, however, unusually impressible. In such per- 
sons, vesicants would necessarily fail in their effects, owing to the 
general disorder which would follow the high degree of erethism of 
the dermoid structure. In such individuals, blisters are never found to 
exert their ordinary salutiferous agency ; on the contrary, the irritation 
they produce is reflected to every part of the economy, and too often-the 
diseased action, for the removal of which they were applied, is, in this 
way, augmented. In like manner, where the powers of the system 
have been greatly reduced, and much nervous irritability has been de- 
veloped, blisters are apt to cause mischief. M. Broussais has made this 
fact the foundation of one of his propositions, — restricting it, however, 
to cases of gastro-enteritis. 

The character and period of the disease have much to do with the 
action of revellents. Every practitioner must have observed, that in 
phlegmasia, when the disordered actions run high, but little effect is 
usually produced by them. The author had an opportunity of witness- 
ing, for a long time, the practice of an individual, much engaged with 
the duties of his profession, who always had recourse to blisters, from 
the first onset of inflammatory affections, and often not only with im- 
punity but with advantage. Such is the practice pursued by M. Gendrin 
of Paris, — the greater part of his treatment in pneumonia and other 
acute inflammations consisting in the application of very large blisters; 
and it is affirmed by two followers of his service at La Pitie, that their 
repeated application, with a very moderate use of blood-letting, was 
attended with very successful results. It is an interesting question, how- 
ever, to solve, — whether the inflammation induced by large and repeated 
blisters may not augment the ratio of the fibrinous element of the blood. 
Experiment can alone determine this. " A large blister," says M. 
Andral, " takes from the blood a certain quantity of its serum ; but 
some fibrin is deposited at the same time at the surface of the sore caused 
by the action of the cantharides. Where there exists in the blood a 
superabundant proportion of fibrin, would this be the means of dimin- 
ishing the excess of that principle in the blood ? Or rather, if the 
action of the cantharides be exerted over a pretty large surface, or the 
inflammation resulting from it be intense, — if, especially, it augment the 
febrile movement already existing, may there not thus arise a new cause 
for a superabundant formation of fibrin ; and may not this cutaneous 



IN FEVERS. 225 

phlegmasia, artificially induced to diminish the intensity of another 
phlegmasia, by the kind of influence which it may exercise upon the 
blood, have the effect of augmenting the morbid condition, which 
represents in the blood the inflammatory state, and marks the intensity 
of it ?" 

Theoretically, it would seem, that if the organic actions are already 
largely exalted, any source of irritation ought to add to such exaltation ; 
the principle, however, that two irritations do not easily exist, at the 
same time, in the body, in the like intensity, applies even here ; and the CYu 
author can say, from extensive observation, that although the beneficial 
agency of revellents is not as marked as where remedies have been 
premised to allay in some measure the tumult, they have not always 
appeared to him to aggravate the disease ; and have often been followed 
by a mitigation of the morbid action. He cannot, therefore, subscribe 
to the opinion of M. Begin, that " in very strong subjects affected with 
intense irritations accompanied with considerable febrile excitement, 
and having their seat in viscera important to life, or propagated to larger 
surfaces, revulsion is next to impossible, and cannot even be attempted 
without danger." The danger does not appear to the author to rest so^ 
much on the employment of revellents, as on the neglect of more 
effective measures, which such cases imperiously demand. 

It has been maintained by M. Broussais, that revulsive irritations must 
always be stronger than those they are intended to replace, otherwise 
they turn to the benefit of the latter ; but this appears to be a mere 
gratis dictum ; and it has, accordingly, been dissented from by many 
of* his followers. Upon the principle of action, which the author has 
endeavoured to lay down, it would seem, that good must always be 
derived from a revulsive irritation in appropriate cases, even should such 
irritation fall somewhat short of the precise degree necessary for com- 
pletely putting an end to the morbid action for the removal of which it 
was adopted. He cannot see how the morbid action must necessarily 
be augmented by it. 

There was a time, when blisters were much employed at a particular 
period of adynamic fever — in the very cases, indeed, in which, accord- 
ing to M. Broussais, they do not render the services expected of them. 
The practice has gone out of vogue in Europe, but it is still followed 
in this country. It consists in applying blisters to the arms and legs in 
protracted fever, when the powers of life have become so far reduced, 
that stimulants appear to be clearly indicated, It has been before re- 
marked, that epispastics are not advisable stimulants in fever; but, as 
revellents, they may be had recourse to, occasionally, with advantage. 
When, for example, the disordered actions, constituting fever, have 
gone on for weeeks, without the existence of any considerable local 
mischief, the revulsive irritation, induced by epispastics, becomes a 
centre of fluxion, so that the mischief is, as it were, localized ; and the 
morbid chain broken in upon. Accordingly, in this way, epispastics may 
be used advantageously in febrile complaints ; but care must be taken, 
that the irritation induced by them is not too intense, so as to be 
reflected to every part of the system, and thus add to, rather than detract 
from, the disorder of functions. In like manner, in chronic irritations of 

Vol. II.— 15 



226 REVELLENTS. 

different organs and tissues, epispastics frequently break in upon the 
nr- habitual derangement of action, and succeed in inducing a salutary re- 
vulsion, after every other medication has failed. 

It would be a matter of moment were we enabled to point out the 
parts of the system, which sympathize with each other, in such sort, that 
if revellents were applied to the one, they might certainly detract from 
the morbid actions going on in the other; but this is a difficult subject 
of investigation, and we are not sufficiently masters of the physiology 
of the animal economy to pronounce with much satisfaction upon it. 
Often, too, we find, that although sympathetic movements may be 
established between different organs, they are by no means of the anti- 
thetic or revulsive kind ; and hence the rule — difficult of execution- 
er has been laid down, that artificial irritants should be made to operate 
upon such parts as perform functions contrary to those of the irritated 
organ ; and always at a distance from those that may sympathize with 
that organ. In elucidation of this, it has been remarked, that the skin 
may be irritated with advantage in pulmonary catarrhs, owing to the 
balance of action existing between it and the mucous coat of the bron- 
chia, but this does not apply to gastritis, as its over-excitations are too 
readily communicated to the stomach. These rules are, however, too 
exclusive ; and every therapeutist must have discovered their inaccuracy 
in the good effects which he has found to be produced by revellents, 
where the lining membrane of the stomach has been more or less in- 
flamed. The severe vomiting, which accompanies such affections, often 
resists every other remedy, and is ultimately arrested by epispastics. 

The true explanation of the action of revellents appears to be the one 
already offered, — that two irritations do not readily exist, at the same 
time, in the system ; so that, if, under proper conditions, during the ex- 
istence of any morbid irritation in an internal organ, an artificial irrita- 
tion be excited at a due distance from it, the morbid process may sub- 
side in the internal organ, and the vital energies be concentrated towards 
the part artificially irritated. Farther than this we cannot go with much 
satisfaction ; and if we attempt to designate the parts, which perform 
functions that are antagonistic to those of the irritated organ, in order 
that we may apply our revellents to them, we may be led to erroneous 
conclusions. On the deeply interesting subject of the sympathies of 
organs, we are but little instructed. We observe the physiological re- 
lations between the stomach and uterus, in the changes induced by 
pregnancy; and the intimate consent between the latter organ and the 
mammae, as evinced in the same changes, as well as in the evolution of 
organs that takes place at puberty; but who could have divined the 
sympathy between those organs, referred to by a modern observer, Dr. 
Rigby, from which, it would seem, practical advantage may be derived 
in the suppression of uterine hemorrhage. Allusion is made to the sud- 
den and powerful contraction, which is excited in the uterus, when in a 
state of inertia, by applying the child to the breast. A common saying, 
amongst nurses— that " the child brings after pains"— shows, that this 
sympathy has been a matter of observation amongst the vulgar ; but Dr. 
Rigby's attention was first directed to it by Carus, who in his " Gyna- 
kologie" recommends the application of the child to the breast, to 



IN THE CHANGEABLE PHLEGMASIA. 227 

promote the expulsion of the placenta. " In cases," he remarks, "where 
there has been considerable disposition to hemorrhage after labour, from 
non-contracted uterus, and where I have been afraid to leave the patient, 
lest flooding should come on in my absence, I have been for the last two ^^ 
years in the habit of ordering the child to be put to the breast, as soon 
as the clothes, &c, were changed, and herself comfortably settled in 
bed, feeling that I thus diminished the chances there might be of any 
hemorrhage occurring. It was not, however, till last year that I began to 
see the practical importance of this sympathetic connexion between the 
breast and uterus in its full extent. Having had two or three cases of 
severe hemorrhage after labour, from uterine inertia, which had to a de- 
gree resisted all the common modes of treatment, and where permanent; 
contraction could not be induced even by repeated injections of cold )(\s^ 
water and vinegar into the vagina, I determined to see what effect the 
application of the child to the breast would have upon the relaxed 
uterus, and was agreeably surprised to find the observation of Profes- 
sor Carus confirmed in its fullest extent, — firm and permanent contrac- 
tion having been immediately produced in every case." 

Admitting, then, that such a sympathy exists, how important, in a 
therapeutical point of view, to be acquainted with it ! It is not, how- 
ever, always easy to apply the child successfully to the breast soon after 
delivery. The young being is awkward ; and cannot seize hold of the 
nipple. In such case, the application of the breast-pump would pro- 
bably be an efficacious substitute. It is certainly worthy of trial ; and 
may be found useful in hemorrhage, which is dependent upon a want 
of due contraction of the uterus. The importance of discovering the 
precise play of sympathies between different organs is strikingly exem- 
plified by this case; and observation may, hereafter, point out many 
others, which may aid us materially, in the therapeutical application of 
our remedial agents. At present, we are greatly in the dark, and most 
of the suggestions on the subject have been hazarded rather from par- 
ticular theoretical considerations than from observation. 

In diseases that are metastatic, — constituting, what have been 
termed, by some, the ( changeable phlegmasise,' — we might seem to 
have an index to the proper organ on which to apply our revellents. 
In parotitis, or l mumps,' after the inflammation has existed for some 
time in the parotid gland, it is apt to quit its seat, and pass to the testicle 
of the corresponding side in the male, and to the mamma in the female. 
In the same way, rheumatism or gout appears to leave the joints ; and 
attach itself to some internal structure. In all these diseases, there is a 
tendency, in particular structures, to be morbidly implicated ; and they, 
who believe in metastasis, consider that there is a true translation of 
,the disease from one part to the other, or at least a decided predomi- 
nance of irritation in the organ sympathetically irritated. " Organs," 
says M. Broussais, "sympathetically irritated, may contract a degreee of 
irritation greater than that of the organ from which they derive their 
irritation : in these cases, the disease changes its seat and name ; these 
are metastases." Others consider that metastasis is a mere extension 
of the disease to structures liable to be affected by it ; — such extension 
occasioning a diminution of diseased action in the part primarily 



228 REVELLENTS. 

affected. For example, the tissue composing the heart and the parts 
about the joints is liable to be attacked by rheumatic inflammation ; 
and, when the inflammation has been seated in the joints for a time, 
and symptoms of pericarditis or endocarditis supervene, it is con- 
ceived, by one party, to be owing to the retrocession of the articular 
inflammation, or to metastasis ; whilst the other maintains, that the 
affection of the heart is simply owing to an extension of the articular 
inflammation, which is more or less diminished in the part first attacked, 
owing to its diffusion over a larger extent of surface. 

But, in whatever light it may be regarded, whenever an affection, 
esteemed metastatic, has diminished in, or left, a part, and become pro- 
minent in a more important organ, the indication to be fulfilled is, in 
the minds of most practitioners, to call back the irritation to the part 
primarily affected, by the application of revellents ; — to the parotid 
region, for instance, where the testicle or mamma has become inflamed 
in parotitis ; and to the joints, in cases of gouty or rheumatic inflamma- 
tion translated or extended to internal organs. The remedy, however, 
is not as clearly indicated as might at first appear. The organs con- 
cerned seem to possess this sympathy only under special morbid con- 
ditions; between which, and the irritation excited by revellents, there 
may not be the slightest similitude ; and this accounts for our want of 
success, when we attempt to recall a changeable phlegmasia back to 
its former seat. In accordance with the views generally inculcated, 
the author has, over and over again, attempted, by revellents, to bring 
back inflammation to the parotid in cases of retrocedent parotitis, and 
/ to the joints, in cases of gout and rheumatism ; but he does not recollect, 
either in his own practice, or in what he has witnessed in that of others 

O^/ — in public or in private — a solitary instance where such an appeal has 
been responded to ; and, accordingly, he now attends exclusively to 
the superinduced affection, and never, for a moment, suffers his atten- 
tion to be diverted from it ; for, in the cases of pericarditis especially, 
which are so often observed as concomitants of acute rheumatism, any 
loss of time might be fatal. It is indeed, by no means clear, that the 
artificial irritation, which we excite by revellents, can be practised, in 
such cases, with perfect impunity. We must bear in mind, that the 
inflammation, which has changed its seat, was originally situate in the 
part we desire to irritate artificially ; and it might be asked, with much 
propriety, whether the revulsive irritation we induce may not equally 

c^pass to the organ secondarily implicated, and add to the mischief 
v already existing; so that, in truth, revellents may be less safe and effi- 
cacious there than when applied to other parts of the economy. 

Contrariety of sentiment exists among therapeutists as to the part to 
which epispastics ought to be applied ; some maintaining, that they 
should be as near as possible to the seat of the disease ; others, at a 

c ^ distance from it. A good deal of this discrepancy has been owing to 
the varying views entertained of the precise modus operandi of epispas- 
tics, — and especially of vesicants. By some, who believe that inflam- 
mation is dependent upon debility of the extreme vessels, and that this 
is always the prominent lesion ; the epispastic is applied as near as 
possible to the seat of the disease, with the view of stimulating the 



WHERE TO BE APPLIED. 229 

debilitated vessels to a more healthy condition. The same practice, 
although on less intelligible grounds, has resulted from the revulsive 
theory ; the idea being, that the nearer the artificial irritation is to the 
seat of the disease, the more powerful and satisfactory will be the re- 
vulsion. This is the view entertained by most modern writers on 
therapeutics ; but it seems to be neither consistent with theory, nor 
with observation of facts. The recommendation, indeed, appears to 
have been handed down from one writer to another, without sufficient 
reflection; and hence we discover no clear ideas either as regards the 
mode of action of revellents, or their therapeutical application. Whilst 
Dr. A. T. Thomson affirms — without offering any reason for the affirma- 
tion — that " blisters, by whatever means they are raised, should be 
applied, as near as possible, to the affected part;" he observes, else- 
where, when treating of the employment of epispastics in apoplexy, 
that " in applying blisters, or employing other epispastics with this view, 
I found them more beneficial when applied to the nape of the neck than 
upon the head." 

Similar diversity is perceptible in the observations of Dr. Chapman 
of Philadelphia on this subject. " It will be right," he says, " in local 
affections, and in the whole of the phlegmasia?, to apply the blister as 
nearly as possible over the immediate seat of the complaint, its efficacy 
thereby being much increased : but wishing to interrupt trains of mor- 
bid association, as in most of the diseases of periodical recurrence, to 
the extremities alternately will answer better. Equally does this precept 
apply in the cases where revulsion is the object" Since this paragraph, 
however, was written, Dr. Chapman's views regarding the action 
of epispastics appear to have undergone some change. In an article 
on tic douloureux, published in the American Journal of the Medical 
Sciences, for August, 1834, he observes: "the common practice of 
establishing issues immediately on each side of the affected vertebra is 
bad. They should be placed some inches from it, and the same remark 
applies to leeching; being near to, or in contact with it, instead of ope- 
rating as divellents or counter-irritants, they may have a contrary effect, 
exacerbating the irritation of the spinal marrow ; but especially the 
intensity of inflammation, which is so apt to follow caustic issues, should 
be avoided. By this circumstance alone, I have, in more than one 
instance, seen neuralgic pain, and the paralytic state, conspicuously in- 
creased, and each again relieved, on the reduction of the inflammation, 
by emollient poultices, &c. Moxa issues are greatly to be preferred to 
those produced by other means. They are less painful, more manage- 
able, and decidedly of superior efficacy." 

This last opinion appears to be more philosophical, and the most in 
accordance with true experience. If we are desirous of irritating the 
vessels of any organ, we apply the blister, if possible, so near to it, that 
we may implicate branches of the same vessels and nerves that proceed 
to the affected part. If, on the other hand, we wish to produce revul- 
sion or counter-irritation — as is almost invariably the case, when we I 
have recourse to epispastics— we carefully avoid applying them to 
branches of the same vessels and nerves, and seek out a surface where 
no such identity of nervous and vascular supply can exist. We can 



\ i 



230 REVELLENTS. 

thus understand that a blister to the shaved scalp may be improper or 
proper, according to the precise character of the disease of the ence- 
phalon, for the removal of which it is applied. In encephalitis, for 
example — affecting the encephalon or its membranes — a vesicatory on 
the head is too near the seat of the disease, and can scarcely fail to add 
to the internal mischief; inasmuch as it occasions an augmentation of 
vital manifestations towards the part irritated, which can only be ac- 
complished by increasing those of the whole head, and consequently of 
the part diseased. Besides irritative irradiations cannot fail to proceed 
through the media of communication between the exterior and interior 
of the head ; and hence it is, that a coup de soleil produces encephalitis* 
— the erethism, occasioned externally by the solar rays, being speedily 
propagated to the organs within the cranium. In like manner, the irri- 
tation of a vesicatory, and of exciting ointments, applied to the head in 
<yv cases of porrigo, has produced serious mischief of the brain by the same 
mode of extension ; and in inflammatory affections of the joints, strong 
revellents applied over the joint may add to, rather than detract from, 
the mischief. 

In the generality of cases, however, in which cutaneous revulsives 
appear to be indicated, there need not be much apprehension from 
placing them as near the affected organ as practicable. Thus, in in- 
flammation of the abdominal or thoracic viscera, the nervous and vas- 
cular distribution is so different in the parietes from what it is in the 
viscera, that we need not hesitate to apply our epispastics to the former, 
whenever the state of internal mischief suggests their propriety. But, 
although blisters may be improper in cases of violent encephalitis, 
before the disease has terminated in effusion, they may be clearly indi- 
cated after such termination, or whenever there is reason to believe 
that advantage may be derived from exciting the organic actions of the 
encephalon or its meninges. In the last stages of the form of menin- 
gitis, to which the name hydrocephalus acutus has been given by many 
nomologists, epispastics may be prescribed ; but, unfortunately, in too 
many cases, without any well-founded prospect of benefit. In like 
manner, whenever the functions of an organ have to be aroused to 
greater activity, the application of a blister so near the organ, that the 
stimulation may be felt by it, may be made with advantage ; but this 
plan of management would obviously be improper, when the organ is in 
a state of superexcitement. 

The author has elsewhere remarked, that in external inflammation, 
in which the dilated state of extreme capillary appears to predominate 
over the excited condition of the vessel communicating with it, we 
often find the direct employment of excitants followed by the most 
happy results. In this way, blisters produce their good effects in super- 
ficial paronychia, and erysipelatous inflammation. In these cases of 
tegumentary inflammation, such a dilated and atonic condition of the 
extreme vessels generally, if not always, exists, which the stimulation 
of the vesicatory is often successful in removing. There are, doubt- 
less, many cases of inflammation of internal organs, which would, like- 
wise, be relieved by the application of excitants, but the organs con- 
cerned are generally so important to the economy, and so intimately 



WHERE TO BE APPLIED. 231 «*— - 

associated by sympathetic relations with those of the vital functions, 
that we dare not venture on their administration. Occasionally, how- 
ever, we observe the reckless empiric exhibit them boldly in such 
affections, and we are, at times, surprised, that the extensive mischief 
which we had anticipated, has not supervened on their use. We could 
understand that gastritis might possibly be relieved by them, in the 
same manner as cutaneous inflammation, but we are astonished to dis- 
cover, that their secondary effect, — that of hurrying the general circu- 
lation and augmenting the inflammatory tendency, — has not taken place 
to the degree we had anticipated. The efforts of a class of empirics, 
not uncommon in every section of the United States, has taught us one 
useful lesson, — namely, that there are diseases, usually and correctly 
esteemed inflammatory, and especially certain stages of such diseases, 
that are not aggravated by the internal use of powerful excitants, which 
seem, at times, to act more as revellents, by exciting the lining mem- 
brane of the stomach, and thus detracting from the intensity of mischief 
existing elsewhere. 

From what has been said of the modus operandi of revellents, it will 
appear, that when we have recourse to them in inflammatory affections 
of internal organs, we avoid applying them so near the seat of the dis- 
ease that it can be increased by their direct action ; much farther than 
this the author's information does not extend : his experience, how- 
ever, has induced him to infer, that the same amount of irritation, arti- 
ficially excited, has had pretty nearly the same therapeutical agency, 
whatever may have been the part chosen for such irritation. The 
selection of a seat for the artificial irritation is often, indeed, sufficiently 
whimsical. It is an old remedy to apply a garlic poultice to the thumb 
in cases of toothache: the vesicatory is put behind the ear in ophthal- 
mia; but, many cases of ophthalmia which had resisted artificial irrita- 
tion, in this situation, have yielded to a vesicatory on the nape of the 
neck ; and others, which have resisted both, have been removed by the 
same agent applied to the interior of the arm : perhaps, however, in 
these cases, the benefit has accrued from the aggregate of successive 
irritations rather than from any one of them. The origin of the choice of 
the interior of the arm was probably owing to the same idea that gave 
occasion to the epithet cephalic to one of its vessels, — some fancied 
connection between it and the head ; but the good results are probably 
owing to the thinness of the skin, and to the greater sensibility of the 
arm, which render it a favourable situation for the induction of revul- 
sion. 

Again, by common consent, we apply our revellents to the feet and legs 
in apoplexy and other cephalic affections ; whilst, in the same diseases, 
— where abstraction of blood by means of leeches, and some degree of 
counter-irritation are demanded,— the French prefer, that the blood 
should be drawn from the region of the anus. With them, greater 
attention is paid than with us to revulsive bleedings, and although their 
notions on the subject may be carried to a somewhat chimerical extent, 
there can be no doubt, that a revulsive influence may be exerted, in 
many cases, by a proper choice of vessels ; — the afflux to the vessels, 
which are discharging the blood, deriving somewhat from organs to 



232 REVELLENTS. 

which it is already directed in too great quantity or force. In the case 
before offered — of encephalitis liable to be augmented by epispastics 
applied to the shaved scalp, — we rarely observe, in American or British 
practice, the revellent applied at a greater distance than the nape of the 
neck. There is no reason, however, why this part should be preferred 
to the top of the sternum, — where the author is in the constant habit 
of applying it in such cases, and, as he conceives, with full advantage; 
whilst there is a cogent objection to the former situation, — its render- 
ing the position on the back uncomfortable, and, at times, impracti- 
cable, owing to the abraded surface being subjected to attrition on 
every change of position of the head. Practitioners have been so little 
in the habit of reflecting on the mode in which epispastics produce 
their salutary agency in these cases, that they rarely select a more con- 
venient, and yet equally effective, centre of irritation, at a greater dis- 
tance from the seat of the mischief. Many of the French writers 
recommend blisters to be placed upon the arm, or between the shoul- 
ders, in encephalitis ; but it has always appeared to the aulhor, that the 
top of the sternum is perhaps the least objectionable situation, when 
counter-irritants are demanded in head affections, that are accompanied 
by exaltation of the organic actions. 

After all, in general rules for the use of revellents, and their adapta- 
tion to special morbid conditions, the physician must be altogether 
guided by sound physiological principles. It is clear, that any agent 
belonging to the class of excitants, when properly administered, is 
capable of exerting a derivative effect, and may be beneficially used 
whenever, owing to the concentration of vital manifestations on any 
important organ, it is considered proper to divert them elsewhere. 



Therapeutical application of Revellents. 

After what has been said of the great principles of action of revel- 
lents, and of epispastics in a general manner, their adaptation to par- 
ticular diseases will be intelligible. 

Intermittents. — During the paroxysms of an intermittent, revellents 
can rarely be demanded. When the cold stage is unusually protracted, 
and no signs of reaction make their appearance about the time when 
they might be expected, — and especially in the pernicious forms of 
intermittent, which occasionally prove fatal in the congestive condition 
of the cold stage, — substances, belonging to this class of medicinal 
agents, may be had recourse to with advantage, for the purpose of con- 
centrating the vital manifestations towards some point of the cutaneous 
surface, and thus detracting from the accumulation that may be present 
in an internal organ. With these views, epispastics may be applied 
over the epigastric region ; — this part of the cutaneous envelope being 
chosen in consequence of its vicinity to the epigastric nervous centre, 
in which, rather, perhaps, than in the stomach, we ought to place the 
' centre of sympathies.' The epispastic, which we choose in the con- 



THERAPEUTICAL APPLICATION. 233 

gestive stage of an intermittent, is usually flour of mustard, applied in 
the form of sinapism or mustard poultice ; and we select it, because its 
operation is more speedy than that of plaster of cantharides. The irri- 
tation, produced by it in the nerves and vessels of the skin, is soon 
extended in all directions; the ganglionic, cerebro-spinal, and spinal 
systems of nerves feel the influence, and, in this way, new force is com- 
municated to the vital movements; reaction becomes established, espe- 
cially if recourse be had, at the same time, to appropriate adjuvants; 
and all apprehension of death during the stage of congestion vanishes. 
The same remarks are applicable to similar conditions occurring in 
diseases of a different character: and, accordingly, whenever a state of 
depression, or of collapse, occurs, which is dependent upon mischief 
existing in some of the great systems, or in some particular organ or 
part of such systems, we endeavour to derive from the organ or part 
morbidly implicated, and to attract the vital manifestations to an unim- 
portant part of the organism, by means of the artificial irritation, which 
epispastics are capable of producing. Hence it is, that the practi- 
tioner employs them in cholera, both during the state of erethism, — 
as indicated by the copious exhalation and secretion from the mucous 
membrane of the alimentary canal, with the pulse still exhibiting suf- 
ficient energy of circulation, — and in that of the oppression and de- 
pression of the vital forces, which characterize the state of collapse: 
— in the former case, to have the benefit of the revulsive medication ; 
and in the latter, of both the revulsion and stimulation, which epispas- 
tics are capable of effecting. In all cases, where time is valuable, and 
revulsion important, the practitioner has recourse to rubefacients whose 
action is speedy ; but, where the case is not so urgent, vesication by 
means of cantharides, is at times preferred. It has been already re- 
marked, that the latter operation or agency on the frame is essentially 
that of the former ; and that, where great prostration exists, the sepa- 
ration of the serum, occasioned by blisters, is rather an objection than 
an advantage. It would be well, therefore, perhaps, that the practi- 
tioner should, in all such cases, place his confidence altogether in the 
former; and this appears to be the feeling of most therapeutists of the 
day. Rubefacients are, indeed, now employed in states of disease, in 
which, a century ago, they would have been looked upon as wholly 
inoperative or injurious. At that time, the idea, almost universally pre- 
valent, was, that the good effects of blisters — and the same applies to 
issues, setons, &c. — were dependent upon the discharge; and, as rube- 
facients produced no discharge, they were necessarily discarded. Here, 
again, therapeutical observation reconducted the speculatist to the true 
path, and taught him practically, that rubefacients are valuable revel- 
lents ; and, accordingly, as in too many cases, the opposite exclusive 
view was embraced by many ; and it is now asserted by several, that 
no good whatever is occasioned by the discharge, — the whole benefit 
being ascribable to counter-irritaiion, or revulsion. Certain it is that 
the main, if not sole remedial effect of cutaneous revellents, in the 
cases under consideration, would seem to be independently of, and not- 
withstanding, the effect produced on the system by the separation of 
the fluid of the vesication from the mass of blood. 



234 REVELLENTS. 

During the state of exalted action, which succeeds the cold stage of 
an intermittent, recourse to this class of remedial agents is seldom ne- 
cessary ; and the same remark applies to the sweating stage. Compli- 
cations rarely exist, which can demand the administration of revellents ; 
and, if any such should arise, the practitioner has to be guided by great 
general principles. The last remark applies equally to the accidental 
complications, that may exist during the stage of apyrexia. Where a 
person has been long resident in a malarious region, or has been sub- 
jected to repeated attacks of intermittent fever, visceral infarctions and 
indurations are apt to be induced, which may act as foyers of irritation ; 
and prevent the tonics, that are administered, from exerting their proper 
agency on the nervous system, so as to break in upon the morbid asso- 
ciation, which keeps up the periodical exacerbations. In these cases, 
it may be necessary — should the disease be of the usual indolent cha- 
racter, which we witness in the indurations of the spleen and liver, to 
which the vulgar have usually given the name ague-cake — to attempt 
their removal by revulsive remedies ; and, with this view, epispastics 
are occasionally applied over the abdomen ; or revellents of a more 
general nature are prescribed, — as preparations of mercury or iodine,*— 
which, by inducing a new artificial condition of the system, derive from 
the one already existing ; and occasion its removal. 

Such are the remedies usually employed in these cases, as well as in 
all those that indicate the presence of local mischief; and for which 
such a system of medication seems to be more appropriate than the 
vigorous employment of antiphlogistics. If we inquire into the exact 
etiology of these visceral engorgements, we may often find that they 
are really only the results of a morbid condition elsewhere, as in the 
lining membrane of the alimentary canal, the irritation extending from 
it to the parenchymatous viscera, and occasioning inflammation and its 
results in those organs; but, in whatever manner induced, and even if 
complicated with some degree of gastro-enteritis, the plan of treatment 
recommended is best adapted for their removal. 

It is not alone, however, in such accidental complications, superve- 
ning in intermittent fever, that revellents have been regarded as appro- 
priate. They have been advised in the apyrexia, with the view of 
preventing the subsequent paroxysm. The mode in which they probably 
act, in such cases, is by attracting the nervous and vascular afflux to the 
part, and concentrating the attention of the patient to the new point of 
irritation. Their operation is exerted in the same manner as mental 
tonics ; and as the animal magnetiser, Perkinist, &c, successfully ope- 
rate on their patients. In cases like these, the remedy ought obviously 
to be applied as near to the anticipated paroxysm as possible ; and, 
therefore, epispastics, which produce their effects at once, are indi- 
cated ; those which, like ordinary blisters, require a length of time 
for the accomplishment of the necessary degree of irritation, and which 
have that irritation diffused through a period of hours, are by no means 
as well calculated for destroying the continuity of the chain, as those 
that make a rapid and powerful impression. A few drops of hot water 
let fall upon a naked surface, or the actual cautery applied a little before 
an expected paroxysm, would, accordingly, be the most appropriate 



IN INTERMITTENTS. 235 

agents; but the acquired dread of fire — although one of the essentials 
to their due efficacy — occasions so much repugnance to their employ- 
ment, that they are scarcely ever used ; and, indeed, we possess in 
agents belonging to other classes — especially to that of tonics — means 
so efficient for breaking the morbid chain, that we very rarely have re- 
course to those of the class now under consideration ; — mental revellents 
or mental tonics being almost wholly handed over to the practisers of 
animal magnetism, and its kindred arts, for operating on the minds of 
the feeble; and for the encouragement of mystery, credulity, and 
delusion. 

Remittent and continued Fevers. — In remittent and continued fevers, 
epispastics are not indicated during the violence of action, which usually 
attends the first periods; unless, indeed, in those fevers that are adyna- 
mic from the commencement, and are complicated with local mischief, 
when they may be required, especially if blood-letting — general or local 
— has been premised. It is chiefly in the latter periods of continued 
fever, when the violence of febrile irritation has, in some measure, passed 
away, that revellents, applied to the cutaneous surface, may exert a 
salutary effect, by localizing that which has been general ; and concen- 
trating the disordered action towards one point — and that an unimportant 
one — of the economy. 

The practice, pursued by some, of attempting to derive from every 
organ that is incommoded by the irregular afflux of blood, which oc- 
curs in the course of remittent fever, by the application of an epispas- 
tic whenever symptoms of such partial afflux present themselves, is 
not judicious. It is apt to keep up irritation, and to add to disordered 
movements, by those irradiations, which are induced by epispastics, and 
which in the opinion of M. Broussais, add to the intensity of inflammation 
of the gastro-enteric mucous membrane. There is a tendency, in all 
these fevers, to run a definite course, and, unless disorganising inflam- 
mation occurs in some part, to terminate in health. The true method of 
treatment is, therefore, to allay all irritations, wherever existent, as 
effectively as possible, and not to adopt any course, during the period 
of superexcitation of the organic actions,* which can augment them. 
But when, as already said, those disordered movements have persisted 
until the period at which the disease ordinarily yields, and appear to be 
likely to be farther prolonged, the application of revellents, which excite 
a new action in the system generally, or in some part of it, frequently 
destroys the chain, and restores all to harmony. It is thus, that a blister 
acts beneficially in such cases, — not as an excitant proper, as elsewhere 
shown ; and that we have the valuable revellent effects of mercury, 
when pushed so as to affect the system in protracted disease. If we can 
once succeed so far as to induce a new action by means of this agent 
on the system generally ; if we can cause the gums to fall away from the 
teeth ; the mouth to be slightly sore, and mercurial fever to be estab- 
lished, we may, generally speaking, look forward, with confidence, to a 
favourable termination ; owing to the incompatibility of the original and 
the artificial irritation in the system at the same time. The very fact of 
our being able to induce a mercurial disorder, is, of itself, an element of 



236 REVELLENTS. 

favourable prognosis ; for, in the worst cases of continued fever, we may 
in vain attempt to arouse the action of the absorbent vessels. The 
gastro-enteric mucous membrane — and indeed the whole system — is so 
excited, that no absorption can be effected, whatever may be the amount 
of mercurials exhibited. These circumstances have led to the belief 
strenuously advocated by some, that so long as high febrile action con- 
tinues, we cannot affect the system by mercury, and that when we do, 
it is an evidence that the fever has abaled, or is about to terminate,— 
not that the mercury has broken in upon the morbid catenation. 

Exanthematous Fevers. — In exanthematous fevers, revellents are 
chiefly employed for the removal of local mischief occurring in the 
course of the malady. In all these complaints, the mucous membranes 
are more or less inflamed ; and, at times, to such an extent as to require 
the ordinary treatment adapted for internal inflammation. It must be 
borne in mind, however, that in such diseases, occurring in young 
children, the dermoid system is very liable to assume gangrenous in- 
flammation, under the irritation of an epispastic. It behooves us, there-'^ 
fore, to be cautious; to be satisfied that it is imperatively demanded; 
to place some substance between it and the skin — as before inculcated, 
— and not to let the plaster remain on too long. Those precautions are 
proper, indeed, whenever it is deemed requisite to apply blisters in the 
diseases of early childhood ; for, although such disastrous results are 
more likely to occur, where the cutaneous system is morbidly affected, 
they may supervene in diseases in no respect exanthematous. 

Inflammation. — It is in the different phlegmasia?, that revellents are 
most frequently, and advantageously employed ; and there is not an 
agent of the class, which has not been used in special cases. Whilst 
the inflammation is active, our attention must be directed to those great 
sedative agents, on which our main reliance is habitually and properly 
placed ; but, when the violence of the phlegmasia has been got under; 
and exaltation of the vital forces continues in the diseased part, revel- 
lents may be prescribed with the best prospect of success. It has been 
before observed, that many of the practitioners of continental Europe 
are of opinion, that blood, drawn from particular parts of the body, in 
diseases of certain organs, is more efficacious than when the same 
quantity of fluid is taken from other vessels. This system of revulsive 
blood-letting is a relic of antiquity. Of old, the vein from which the 
blood was to be taken in any disease was specified ; and, at one period, 
great discussion was carried on, respecting the propriety of bleeding 
from the vein of the arm of the affected side in pleuritic inflammation, 
or from that of the opposite one. Strangely enough, an appeal was 
made to the Emperor Charles IX. ; but, before he delivered his judg- 
ment, he was bled for pleurisy, and died ; and his death was of course 
ascribed to the blood having been drawn from the wrong side. These 
injudicious controversies are no longer carried on ; and practitioners have 
settled down to the opinion, that the effect upon the system is the main 
thing to be regarded ; yet a modern therapeutical writer, Conradi, main- 
tains, that in thoracic inflammation blood should be drawn from the arm 



IN EXANTHEMATOUS FEVERS. 237 

of the affected side. This is a topic, however, to which allusion will be 
made hereafter. It will be then seen, that there may be cases in which 
greater advantage may be derived from emptying the vessels of the in- 
flamed organ, than where the blood is taken from a more distant vessel. 
' Revulsive bleeding' — as it has been termed — alone concerns us at 
present. American and British practitioners attach, perhaps, too little 
importance to this matter, although too much weight is, doubtless, 
given to it elsewhere. If we are in the habit of exciting a revulsion in 
the feet, or in the rectum, in encephalic affections, there is some show 
of reason in our drawing blood from the feet or from the neighbourhood 
of the anus ; and when the author has seen it practised in France, by 
opening a vein in the foot, and immersing it in warm water, — or by 
applying leeches around the verge of the anus, a greater effect, it 
appeared to him, was produced on the system by a smaller loss of 
blood, than where the abstraction of the fluid was made from the 
exterior of the head — for example. Many of the European practitioners 
are firmly of this opinion, and they, consequently, have recourse to 
these revulsive bleedings in all such affections. 

Revulsive bleedings from the neighbourhood of the anus were so 
common at one time in Great Britain, as to be alluded to in the popular 
songs. Thus, a wit of the time of the "Rump Parliament," — alluding 
to Cromwell's hunting the members out of the house by military force, — 
observes * — 

" Our politic doctors do us teach, 
That a blood-sucking red coat 's as good as a leech 
To relieve the head, if applied to the breech." 

Although doubts may be entertained regarding the propriety of placing 
any stress upon the revulsive effect of general, there can be none as re- 
spects the action of topical, bleeding. Often, indeed, when we are in 
doubt regarding the propriety of the former ; and when the degree of 
phlegmasia seems to require the farther abstraction of blood, we can 
obtain the most striking advantage from the combination of revulsion 
and evajjiation, which cupping or leeching affords. It is, in truth, in such 
cases, tnlt we avail ourselves of the use of these mixed agents, rather 
than of more powerful simple revellents. These we usually postpone, 
until the inflammatory action has been more decidedly reduced. When, 
therefore, we wish still farther to diminish the quantity of circulating 
fluid or the activity of the circulating forces; and, at the same time, are 
somewhat afraid of general blood-letting; and when we do not consider 
the condition such as to admit of the application of more active counter- 
irritants— as blisters — we have valuable agents in means, that remove 
a small quantity of blood from the vessels, and are, at the same time, 
decidedly revellent in their action ; and it has always seemed to the 
author, that the good effects of cupping and leeching, in many cases of 
internal inflammation, have been as much dependent upon the latter 
operation as upon the former. Even the simple application of cups, 
without the scarificator, constituting dry cupping, is often signally salu- 
tary; and where there is, in addition, the irritation, or series of irrita- 



238 REVELLENTS. 

tions, produced by the wounds of that instrument, the revulsion is still 
more marked. In the same manner, the punctures made by leeches 
are the source of salutary derivation. 

It has been the opinion of many therapeutists, that local bleeding is 
of but little service, compared with bleeding from the larger vessels ; 
and that the effects of both are proportionate to, the quantity of blood 
taken. Were this the sole effect, that local blood-letting is capable of 
producing, the objection would be valid ; but such is not the fact. It 
has been already stated, that revulsion is an important agency; — not 
less so, perhaps, than depletion ; and hence cupping and leeching may 
be employed successfully in cases, in which the same, and even a larger 
amount of blood taken from the arm would be far less efficacious. 
When, therefore, we are desirous of evacuating the vessels, and of 
diminishing the vital actions generally, and, through them, those of any 
part affected with hyperaemia, we can employ no substitute for general 
bleeding ; but where the inflammatory or subinflammatory irritation is 
not to such an extent as to demand the use of the lancet, or to require 
much loss of blood, topical blood-letting may still be beneficially em- 
ployed. In all fevers, consequently, where there is a complication of 
local hyperaemia, but to no great extent, we adopt topical revulsive 
bleeding unhesitatingly and freely ; and, in the practice of the Brous- 
saist, — if any such there be at the present day, — it is used in most cases 
of fever to the exclusion of the lancet; leeches or cups being applied 
over the epigastric region, in accordance with the views of that patho- 
logist, who, as often observed, placed the local origin of all fevers, or 
of most fevers, in the gastro-enteric mucous membrane. A like treat- 
ment is suggested by the views which regard dothinenteria or follicu- 
lar gastro-enteritis, as the cause, essence, or consequence of ataxic and 
adynamic fevers. 

There is no variety of revulsion that has not been employed in the 
management of the phlegmasia?. The author has already remarked 
that every local stimulant, whatever may be the organ or tissue on 
which it acts by preference, is a revellent ; and, accordingly, all local 
stimulants are used in the treatment of inflammation. Epispastics, too— 
our great counter-irritants — are employed under the like circumstances ; 
and the operation of all, in the removal of disease, is the sameT 

As regards local stimulants, we rarely have recourse to them as re- 
vellents, until the time has come when we can adopt advantageously 
the whole revulsive system of medication. There are cases of inflam- 
mation, however, in which the inflammatory chain may be at times 
severed, at an early period, by revellents. The author's friend, — Dr. 
R. H. Thomas, of Baltimore, Professor of Obstetrics in the University of 
Maryland, — informed him, that in cases of mastitis or mastodynia apos- 
tematosa occurring after delivery, when the symptoms have strongly 
threatened suppuration, he has completely and suddenly removed the 
hyperaemia by a combination of sulphate of magnesia and tartrate of 
antimony and potassa, given so as to produce full vomiting and 
purging. In this way, an afflux of vital activity was provoked 
towards the abdominal organs, and a corresponding derivation took 
place from the inflamed mamma. A similar course of treatment is said 



IN THE PHLEGMASIA. 



239 



to have been found useful even in cases of peritonitis ; but notwithstand- 
ing the salutary revulsion that might be effected by the vomiting, appre- 
hension may be entertained that irritation, excited in the intestinal canal 
by the cathartic, might be propagated, by contiguous sympathy, to the 
part labouring under inflammation ; and that more harm might accrue 
from the excitation, thus occasioned, than good from the revulsion. 

Under the different classes of remedies that act as local excitants 
allusion has been made to the revulsion they are capable of operating, 
and to the cases of disease in which they have been employed by reason 
of this operation. It will not, consequently, be requisite to dwell upon 
them here. It may be merely observed, that whenever we consider 
internal revellents to be indicated in cases of hyperemia of an internal 
organ, we generally choose the lining membrane of the intestinal canal 
on which to effect such revulsion ; and, accordingly, emetics and 
cathartics are our most valuable internal revellents. 

In all the varieties of internal inflammation, when the exaltation of 
organic actions has been reduced by appropriate medication, epispastics 
are employed ; and the blister of cantharides is usually selected for this 
purpose. Sometimes, however, nitrate of silver, red iodide of mercury, 
ammoniated lotions, &c, are chosen, where cantharides are known to 
irritate inordinately, or where the object is to excite vesication more 
speedily. Of the best mode of applying those agents, and the great 
general principles to be attended to, mention has been made already. 

When we are desirous of maintaining a succession of revulsions, or 
a constant revulsion, we employ either repeated blisters, or keep the 
blistered surface discharging by the application of blistering salve ; or 
we have recourse to some of the other epispastics, as moxa, the seton, 
the issue, ointment of tartrate of antimony and potassa, &c, &c. The 
last agent is well adapted for cases of chronic inflammation and for 
phthisis ; because, whilst the pustules, induced in any one part of the 
exterior of the thorax, or elsewhere, are going through the stages of in- 
crement and maturation, a fresh crop can be elicited on some other part 
of the chest; and thus a succession of irritations may be developed, 
which, as before said, is more beneficial than one that is permanent. 
In these, and similar cases, therefore, pustulation, effected by this oint- 
ment, is preferable to the issue or the seton, which, when once intro- 
duced, are permanent so long as they are permitted to exist; and as 
their good effects are mainly owing to the irritation and consequent 
revulsion, and as the system soon becomes accustomed tojthe discharge, 
and advantage can scarcely be expected from it, it is better to select 
more cleanly and less objectionable counter-irritants. It is at times, 
however, difficult to induce the patient to submit to any kind of epis- 
pastic, or to persevere in the use of those, which, like an ordinary 
blister, or ointment of tartrate of antimony and potassa, may require a 
repetition of the application. It' may, therefore, be advisable to fix 
upon a method of revulsion, which, when once established, can be 
maintained without difficulty : and, for this reason simply, the issue, or 
seton is often selected, especially in hospital practice. There are situa- 
tions, too,- in which there maybe some difficulty in our having the 
remedy properly applied, unless it is established at once ;— when the 



240 REVELLENTS. 

patient, for instance, is compelled to subject himself to the inconve- 
nience of a constrained posture, — as where the vertebral column is 
affected with chronic inflammation, and the bones themselves with 
caries. In such cases, we insert a seton, or establish an issue, on each 
side of the affected vertebra, and keep this open as long as we think 
the diseased condition requires it. Still, even in these cases, a succes- 
sion of revulsions would, probably, be more effective than this protracted 
and constant irritation. 

Moxa is rarely employed in the more active inflammations. It is 
more commonly used in those cases, in which the seton or the issue is 
demanded ; and where it is desirable to break in upon a morbid cate- 
nation that has been long existent. A centre of fluxion is formed in 
all these cases ; the vital manifestations are directed towards the part 
artificially irritated ; and, at times, the derivation is so complete, that 
the disease is removed, as it were, by a charm. In this way, moxa 
occasionally produces good in mania. The author has applied it in 
some cases with the effect of so completely directing the attention of 
the maniac to the cauterized part, and towards the artificial irritation 
there established, that it has broken in upon his abstractions, aroused 
him to consciousness, and been followed by decidedly beneficial results. 

What has been said of the general rules for guidance in the applica- 
tion of revellents, near to, or at a distance from, the diseased organ, 
will render it unnecessary to say more here, than to remind the reader, 
that where revulsion has to be operated, the counter-irritant must not 
be applied over the same vessels and nerves, that are concerned in the 
lesion. A part of the body must be chosen, whose vessels and nerves 
are not so connected with the seat of the disease, that when the nervous 
and vascular afflux is solicited into them, the exaltation of action may 
be participated in by those of the part affected. 

In chronic ophthalmia, it is very common for the unprofessional to 
select the interior of the arm as the best locality for a seton or issue; 
but, although this situation may have been chosen originally for the 
reasons before mentioned, connected with the idea that some more par- 
ticular relation exists between the vessels of the arm and those of the 
head, the custom is kept up, perhaps, in consequence of as little incon- 
venience accruing from the presence of the issue there, as in any part 
of the tegumentary surface that could be selected for the purpose. 

As in cases of long sustained febrile irritation, so in those of an in- 
flammatory character, when they have become chronic ; mercury is a 
valuable revellent. By the new action which it establishes, it breaks 
in upon the morbid condition more effectually than any. other agent. It 
is in such cases, too, that we frequently see the most marked results 
from] the revulsion effected by change of air, and of all the physical 
influences surrounding the individual ; but this course 'can be adopted 
only when all active disorder has subsided. 

Arthritic Fevers. — From the great leading rules laid down with re- 
gard to the employment of external revellents in the phlegmasia? in 
general, it is unnecessary to occupy time and space with the special 
consideration of individual maladies. Allusion may be made, how- 



IN THE PHLEGMASIA. 241 

ever, to one of those singular discrepancies in medical opinion, of 
which we have, unfortunately, too many examples ; but which gen- 
erally, perhaps, owe their origin to defective observation or reflection, 
or to both. It regards the propriety of employing epispastics in rheu- 
matism and gout. " Of the utility of blisters in rheumatism," says 
Dr. Chapman, of Philadelphia, " no one doubts. Yet even here they 
are productive of harm, if prematurely applied, and, where it can be 
conveniently done, should be preceded by general evacuations and local 
detractions of blood. My conviction is, that they are much better 
adapted to chronic than acute rheumatism, almost always proving ser- 
viceable in the former instance, and especially when they induce the 
suppurative process. By some writers it is recommended to vesicate 
the affected part in regular gout, and, as it proves so beneficial in some 
analogous cases, we might imagine, that it would be attended with the 
same results ; on trial, however, I have been disappointed, and no 
longer employ applications of this nature. It has, indeed, been alleged, 
that they have the effect of repelling the disease on some internal part 
of more value to life, and hence are hazardous measures. But such 
applications are the very best means to invite and fasten down, if I may 
use the expression, gout on the extremities, and I can have no idea of 
a remedy blowing hot and cold in this way." It is proper to remark, 
however, that these view r s of Dr. Chapman were published many years 
ago. In his recent work on 'Eruptive Fevers,' &c, (Philadelphia, 
1844,) he says his own experience with blisters in gout " is too limited 
to decide confidently on the matter." l£ But," he adds, '* from analogy, 
as well as on account of what I have/ seen of their operation, I presume 
that, after a partial reduction of the phlogosis, they would be service- 
able — which opinion is strengthened by the consideration, that counter- 
irritation by some means seems always to have been a favourite practice 
in such cases." 

On the other hand, Dr. A. T. Thomson thus expresses himself on the 
same subject : — " In gout and rheumatism, the application of epispastics, 
whether vesicants or rubefacients, is more problematical. ' Blistering,' 
Dr. Cullen remarks, * is a very effectual means of relieving and discuss- 
ing a paroxysm of the gout, but has also frequently had the effect of 
rendering it retrocedent.' I have little experience of the truth of this 
observation in gout, having scarcely ever ordered the application of 
epispastics; but, in acute rheumatism, I have so frequently seen the 
most alarming translation of the inflammation to the vital organs, that I 
cannot too strongly denounce their employment in this disease." 

The reader is referred to a preceding page for the analysis, which the 
author has endeavoured to make of the action of revellents in the change- 
able phlegmasiae. They are signally applicable to the present inquiry, 
both rheumatism and gout belonging to these very phlegmasise. It was 
there remarked, that it is by no means clear, that the artificial irritation, 
excited by revellents, can be used in such cases with perfect impunity. 
The irritation excited by the epispastic may, indeed, be added to that 
which appertains to the disease ; and if there be a disposition in the 
phlegmasia to change its seat, or to extend to analogous structures, — 

Vol. II.— 16 b 



242 REVELLENTS. 

the gouty, or rheumatic irritation in such structures may be augmented 
by it ; bat it is not easy to see that it can have the effect, either of 
" fastening down" the gout on the extremities, according to the view of 
Dr. Chapman ; or give occasion to metastasis, according to that of Dr. 
Thomson. The disease itself — as well as rheumatism — is metastatic or 
changeable ; and this, whatever may be the plan of treatment pursued, 
although the author is not prepared to say, that such change of seat may 
not be promoted by certain agencies rather than by others. He has had 
the misfortune to witness several cases of serious pericarditis and endo- 
carditis occurring in the course of acute rheumatism, although neither 
blisters nor any other applications had been made to the affected joints ; 
yet he has little doubt, that had they been employed, the metastasis, or 
extension of the disease, would have been ascribed by Dr. Thomson, 
and by those who think with him, to the epispastics. 

But although difference of sentiment exists regarding the effects of 
epispastics in acute gout, and acute rheumatism, practitioners are agreed 
as to the benefits to be derived from them, when the gout is atonic, and 
the rheumatism chronic. They are then used by all ; and in the latter dis- 
ease especially, revellents of almost all kinds are more or less prescribed ; 
— all the varieties of epispastics are applied in some condition or other, 
and by some practitioner or other ; the urinary organs are irritated by 
the turpentines, whose action in such cases is wholly revellent ; and, in 
the cases of rheumatism, or neuralgia, to which the terms lumbago and 
sciatica have been appropriated, the excitation, produced in the urinary 
organs, exerts a salutary agency, — the new impression, made there, de- 
riving, or detracting from the neuralgic condition in the lumbar orcoxal 
region. In some of these cases, the use of phosphorus, or moxa, or the 
actual cautery in its ordinary form of application, has destroyed the 
morbid action when other external revellents had failed. It is in such 
cases, too, that the new nervous impression made by acupuncturation is 
so advantageous. 

In consequence of the easy absorption of the cantharidin when the 
flies come in contact with an abraded surface, blisters have been con- 
sidered improper in inflammatory conditions of the urinary organs; but 
the plan, to which the author has already adverted, of placing a material 
between the plaster and the skin, obviates this objection ; and permits 
counter-irritation by those agents to the same extent as if the inflamma- 
tion were seated in any other organ. 

Hemorrhage. — The remarks, that have been made on the employ- 
ment of revellents in inflammation, are equally applicable to hemor- 
rhages. When hyperaemia exists in any tissue, the action of a revellent 
detracts from that hyperaemia, whether its presence be indicated by the 
ordinary signs of inflammation, or by the occurrence of hemorrhage. 
Accordingly, the various forms of revellents are prescribed in these 
cases with advantage. Emetics and cathartics exert their efficacy in 
hemorrhage rather by their revulsive than by their depleting or eva- 
cuant properties; and the great general principles that guide the 
practitioner in the administration of revellents in the phlegmasia must 
regulate him here. It has been before remarked, that substances or 



IN MENTAL AFFECTIONS. 243 

agencies, belonging to this class, often act in the most salutary manner 
as indirect astringents, by causing a diversion of the blood from the seat 
of the hemorrhage ; and that in this way the application of cold to the 
nape of the neck, and charms, are haemastatics. Led by the great prin- 
ciples referred to, we excite the feet, or the rectum, in apoplexy ; apply 
vesicants, suppurants, or rubefacients to the exterior of the thorax in 
haemoptysis, — endeavouring, in this manner, to establish a centre of 
fluxion in some part of the organism, which does not receive its blood 
from the same arterial trunks as are concerned in the hemorrhage. Even 
in cases of the less active and passive kinds of hemorrhage, advantage 
is derived from the employment of revellents ; and they are, consequently, 
amongst the remedies most frequently used, whenever a discharge of 
blood from any set of vessels is kept up for a length of time ; precisely 
for the same reason that we have recourse to them, in prolonged mor- 
bid conditions of any internal organ. 

In the haemoptysis, that is symptomatic of phthisis, and in phthisis 
in general, revellents are more relied upon than any other class of 
remedies; and, if they fail, as almost every agency does when the dis- 
ease is once fixed in the pulmonary tissue, we cannot look, with any 
well founded expectations of benefit, to any other division of thera- 
peutical agents. The revulsion is here variously effected ; — sometimes 
by cantharides ; at others, by tartar emetic ointment, moxa, issues, the 
seton, &c, &c. The object being to establish and maintain a centre of 
fluxion on the exterior of the chest, a succession of blisters, or the tartar 
emetic ointment, is well adapted to the case; but the issue or the seton, 
when once inserted, being easily kept up, is preferred by some physi- 
cians and patients. 

Diseases of the nervous system. — With regard to the employment of 
revellents in affections of the nervous system, much need not be said. 
The author has already spoken of their utility in apoplexy, when con- 
sidering their use in hemorrhage. In paralysis, epispastics are often 
had recourse to, but never, perhaps, with the view of producing revul- 
sion. They are employed altogether as excitants proper ; and have, 
accordingly, been considered under that division of medicinal agents. 

In mania, every variety of revellent has been used. Whether the 
disordered intellect has arisen in the ordinary course of life, or in the 
puerperal state ; whether it has been hereditary or acquired, the mis- 
chief has too often been regarded as requiring exclusively physical 
management ; and most of the agents, that have been advised, have 
been of a kind adapted for repressing inordinate organic actions. That 
the disease is of a physical nature, or dependent upon an altered con- 
dition of the organ, through which the mental and moral manifestations 
are elicited, is perhaps unquestionable ; but it is not of such a character, 
in the majority of cases, as to be removed by those agents, that are 
adapted for removing a hyperaemic condition of the encephalon ; and, 
whether these, or, indeed, any physical agents have to be employed, 
must depend upon the particular circumstances that occasioned, or are 
present, during the disease. As a general rule, we are constrained to 
confine the treatment to the influence which we can exert on the 
encephalon through the moral; and, by a proper application of mental 



244 REVELLENTS. 

revellents — if they may be so termed — to break in upon the insane hal- 
lucinations. A modern writer, Dr. Gooch — in a lucid and philosophic 
essay on the " Disorders of the Mind in Lying-in Women" — has the 
following remarks, which are applicable to mental alienation in general. 
" Whatever may be the causes which excite these diseases, the most im- 
portant question still remains to be considered : — what is that morbid 
state of organization on which the disorder of the mind depends ? This is 
the proper object of medical art. We have no power by medicinal 
agents of relieving a disordered mind, excepting indirectly through the 
disorder of the body with which it is connected. It is impossible 
therefore, to stir one step in the treatment of the disease without first 
ascertaining what this disorder is ; or if different in different cases, what 
they are, how to discriminate them, and whether experience shows that 
one is more common than the other. There is a strong disposition, not 
only popular but professional, to attribute raving of the mind to inflam- 
mation of the brain. Perhaps it originates in this — that the disorder of 
the mind with which we are most familiar is drunkenness, which is 
known to be caused by spirits, and to be cured by temperance. Mania 
is called brain-fever, and the sight of a raving patient instantly suggests 
the thought of cupping-glasses, iced-caps, low diet, and purgatives. 
This view of mania is, when it occurs in childbed, still farther corro- 
borated by the popular notions about lying-in women. If a woman 
becomes deranged in childbed, it is said not only that she has a brain- 
fever, but that the milk has flown to her brain, hence the term ' mania 
lactea.' Dr. Denman says, that in his time it was a prevalent notion 
among the people, but an obsolete one in our profession ; and formerly 
it was usual to attempt relieving the disease by restoring the milk and 
the lochia. It would be as good pathology to attribute puerperal fever 
to a suppression of the milk, and as good practice to attempt to cure it 
by drawing the breasts, fomenting the pelvis, or using any other local 
means for restoring these secretions. But experience and reflection 
lead to very different conclusions: they teach us that the disorder of 
the mind may be connected with very opposite states of the circula- 
tion, sometimes with inflammation or active congestion, for which deple- 
tion is the shortest and surest remedy; sometimes with an opposite 
condition of the circulation, which depletion will only aggravate. 
Cerebral excitement does not necessarily depend on inflammation or 
congestion, nor is depletion, however moderate, necessarily the proper 
remedy. Cerebral excitement is often aggravated by depletion ; and 
in some cases, as I shall have occasion to relate, absolutely brought on 
by it. Now the question, what is the morbid state of organization on 
which puerperal insanity depends, must be determined in the usual 
way. There is only one safe mode of working the problem, by observ- 
ing the causes which brought on the disease, the bodily symptoms 
which accompany it, the way in which it is affected by remedies, and 
the morbid appearances discovered after death. These points can be 
learned only by an attentive and thoughtful observation of cases, and 
will be best communicated by the relation of them." 

For the removal of most of those bodily symptoms, that are usually 
observed in mental alienation, much use is made of agents of the revel- 



IN MENTAL AFFECTIONS. 245 

lent kind. If there be headache; suffused eyes; flushed face, &c, 
general blood-letting may be demanded ; but usually the combination 
of depletion and revulsion, afforded by cupping, is sufficient for the 
evil, and more beneficial in its operation than general blood-letting. 
In furious mania, epispastics to the head, nape of the neck, or to the 
lower extremities, have been strongly advised by some ; but although, 
as has been seen, they may occasionally break in effectually upon the 
abstractions, they frequently add to the excitement, by the irritation 
they produce; and cannot often be indicated. As a general rule, the 
soothing or abirritating system of management is required, and if the 
patient be indomitable by other agents, recourse may be had to the 
douche, which rarely fails. In all insane establishments an apparatus of 
the kind exists. It consists of a reservoir above the ceiling of the 
apartment, from the bottom of which a plug can be withdrawn, so that 
a column of water may be made to impinge on the naked head. The 
powerful revulsive impression made on the nervous system by the 
" shock" from the fluid rarely fails to tame the most furious. Even the 
cold dash or douche, or spout bath, is often sufficient for the purpose ; 
and the means are always at hand. The head of the patient may be 
placed over a pail of water, over the edge of the bed, and water be 
poured from a watering pot, or other vessel, — the operator standing on 
a chair, and in this manner allowing the water to fall from a height. A 
professional friend informed the author of a distressing case, in which 
he employed this variety of the douche with signal advantage ; and 
several such cases have occurred to the author himself. A lady, in 
consequence of the abrupt announcement that her son, a fine boy, was 
burnt to death, became frantic, and was completely unmanageable, 
until the douche was employed in the mode just described ; under the 
operation of which she was gradually overpowered, and sank to sleep. 
Since the introduction of this agent, more violent means of restraint in 
mania have been almost abandoned; and, by analogy, the cold dash 
or douche has been employed with signal advantage in various other 
morbid encephalic conditions, — as convulsions, poisoning by opium, 
delirium tremens, &c. 

Where mental alienation has persisted for some time, and adequate 
attention has been paid to appropriate seclusion, and to preventing, as 
far as possible, the intrusion of any insane idea, the most salutary revul- 
sion is occasionally effected by that thorough change in all the physical 
influences surrounding the individual, which travelling affords. The 
new objects, which perpetually present themselves to the eye, keep the 
mind actively engaged, and prevent it from brooding upon any topic, 
which may have constituted the insane hallucination. Exercise and 
amusement out of doors are, indeed, amongst the most important of 
the agencies adopted in the treatment of insanity ; and every well con- 
stituted private or public institution for the insane is provided with 
means for keeping the mind engaged, and amused. Some of the pri- 
vate establishments, in France and elsewhere, are admirably supplied 
in this respect. If the patient choose the more active games, of which 
there is an extensive selection ; or if he prefer riding, or sailing,— for 
there is usually a considerable basin of water, in some part of the Ferme 



246 REVELLENTS. 

orn&e, or if he select the exercises of horticulture or agriculture, he 

is always indulged, care being taken to discriminate, whether he be in a 
state to permit the recreation, with or without his keeper. Trie whole 
system of moral management is, indeed, one of revulsion. It consists 
in keeping the mind engaged on every topic except the one that is pre- 
dominant ; or, as the phrenologists would say, in having every cerebral 
organ of the mental and moral manifestations occupied, except the one 
which is prominently, if not solely, diseased. 

Hysteria, the seat of w r hich is the cerebro-spinal nervous system 
especially, is mainly treated by revellents, as by cupping over the sides 
of the vertebral column, or elsewhere; by stimulating injections; the 
cold douche; and nauseous antispasmodics, as they are termed; — all 
of which exert their beneficial effects through the new impression they 
excite on the nerves with which they come in contact, thus detracting 
from the nervous concentration towards some other point of the nervous 
system, and generally, perhaps, of the cerebro-spinal axis. 

In tetanus, and hydrophobia, revellents are rarely used, if we except 
the cold affusion, which, in one case of tetanus algidus or tetanus arising 
from cold, that fell under the author's observation, removed all the spas- 
modic symptoms by the shock it occasioned. 

In convulsions, epilepsy, and chorea, epispastics are rarely employed; 
and never without some accidental symptom is present, which appears 
to indicate their use. In the two last diseases, however, the most salu- 
tary operation is occasionally exerted by a thorough change of all the 
physical influences surrounding the individual. The disease appears, 
at times, to be kept up altogether by habit ; and change of air and scene 
frequently break up the morbid associations better than any other 
agency. 

In neuralgic affections of various kinds, the practitioner trusts mainly 
to the effect of new impressions made upon the nerves. In this way 
tonics act, and the same may be said of narcotics. It is in such cases 
that the use of galvanism — in its various forms of application — as well 
as of the mineral magnet, has been found efficacious, breaking in upon 
the morbid condition, by exciting impressions on nerves not implicated 
in the disease, and, at the same time, attracting the nervous influx and 
the attention of the patient to the nerves artificially excited. In like 
manner, cupping — both with the scarificator, and dry — is often benefi- 
cially employed as a revulsive agency. 

Dropsy and hypertrophy. — From what has been said regarding the 
action of revellents — mental as well as physical — it can be understood, 
that in dropsies, as well as in hypertrophy of various kinds in the solid 
structures of the body, the different forms of revulsion may be advan- 
tageously employed. The reader is referred to the section on Eutro- 
phics, and to those on the various local stimulants, for elucidations on 
this point. In hydropic affections in general, blisters appear to- be more 
indicated where there is much local irritation, as in hydrothorax— 
which is usually a sthenic dropsy. Still, in all, they establish a new 
action in the nervous and sanguiferous systems ; and cases are on record, 



SPECIAL REVELLENTS. 247 

in which the discharge from the blistered surface has been so profuse as 
to constitute an outlet, as it were, for the fluid of the dropsy. 

It is obviously impossible to point out every variety of morbid con- 
dition, in which revellents may be useful. They can easily be inferred 
by one, who has attended to the great general principles which the 
author has endeavoured to lay down. In other works he has pointed 
out the advantage to be derived from the revulsion, which change of air, 
society, and scenery, are capable of effecting in health : and an atten- 
tive consideration of both its hygienic and therapeutical relations and 
applications cannot fail to exhibit it as one of the most important of the 
agencies which we employ both in prophylactic and curative medicine. 



SPECIAL REVELLENTS. 

From the general remarks that have been made, it is clear, that every 
physical and moral agent capable of modifying the function of innerva- 
tion, and, through it, those of circulation and secretion, must be capable 
of acting as a revellent ; and, therefore, that all the classes of therapeu- 
tical agents hitherto considered, and most — if not all — those that have 
to come, must be esteemed capable of revulsive operation in particular 
cases. Enough has, however, been said in regard to them ; and, there- 
fore, under special revellents those only will be considered which act 
as Cutaneous Revellents, comprising what have usually been classed 
together under the head of Epispastics. The class will, however, 
admit of certain subdivisions, which may tend to facilitate the study of 
the modus operandi of the individual agents; most of which have been 
described under the head of Excitants, and will, therefore, require but 
a brief consideration here. 

a. Rubefacient Revellents. 

1. SINA'PIS.— MUSTARD. 

The excitant properties of mustard have been described elsewhere, 
(Vol. i. p. 133,) and the fact that vinegar and other acids interfere with 
the formation of the acrid principle, especially in black mustard, has 
been particularly noticed, (Vol. i. p. 134). On this account it is ad- 
visable, that the sinapism or mustard poultice or mustard cataplasm or 
mustard plaster , should not be made with boiling vinegar, as directed 
by the London and Dublin Colleges; but that water of a temperature 
not exceeding 100° should be used, as heat itself appears to be in- 
jurious. It is always made extemporaneously, and, therefore, the 
framers of the Pharmacopoeia of the United States have properly omit- 
ted it. As a local stimulant, its use has been pointed out elsewhere, 
(Vol. i. p. 476). It is likewise used as a revellent in various neuralgic 



248 SPECIAL REVELLENTS. 

and other painful disorders of internal parts, where it is necessary to 
establish an action of revulsion speedily. Care has, however, to be 
taken where the sensibility is diminished, as in apoplectic and paralytic 
cases, lest it should be kept on so long, that vesication, and even slough- 
incr may occur. Usually, where the sensibility is not much impaired 
a stinging pain indicates that the excitant is taking effect ; and, if 
rubefaction be induced, it ought to be removed, and the mustard be 
carefully washed off, should any adhere. The best plan, indeed, is to 
put the cataplasm between gauze, which prevents any adherence to 
hairs, &c. These ought, however, when numerous, to be shaved off 
when the cataplasm is placed in immediate contact with the skin. 

The strength of ordinary mustard varies materially. Usually, for 
simple rubefaction, equal parts of flour and mustard, mixed with warm 
water, will form a sinapism of the proper strength. 

In violent neuralgic and other deep-seated pains, the sinapism is 
occasionally applied to excite vesication. For this purpose, it may be 
made altogether of flour of mustard. It is, however, a very painful 
application, and, unless carefully watched, may implicate the integu- 
ment so seriously, as to give rise to alarming sloughing. Hence, it is 
not often used as a vesicant. Oil of turpentine is occasionally added 
to the sinapism to increase its excitant effect. 

Volatile oil of mustard — Oleum Sinapis — is a powerful acrid, ex- 
haling so strong a smell of mustard that the attempt to test its odour 
excites a violent pungent sensation in the nose, and tears in the eyes. 
Its acridity is so great, that its application to the sound skin immedi- 
ately occasions a sense of burning, and intense redness and vesication 
in the parts with which it is made to come in contact. It is applied in 
two modes, according to the sensibility of the skin, and the effect it 
may be desirable to induce. These consist either in rubbing the liquid 
on a part of the surface, or in applying strips of linen wetted with it. 
The first method is advisable where the skin is delicate, — as in the cases 
of women and children, and in those whose sensibility has not been 
diminished, as by paralysis. When rubbed on the skin it speedily 
evaporates, exciting a sense of burning and redness, which disappears 
in a few hours. The application of the oil by means of strips of linen 
is adapted for skins which are thicker and less sensible, as well as for 
morbid cases, in which the sensibility is diminished. A strip or strips 
of linen dipped in it are placed upon the skin and suffered to dry, 
which generally takes six or eight minutes. The pain is often most 
violent, and sometimes insupportable ; and is followed by redness and 
vesication. It has been extensively used in Germany, especially in 
cases in which a sudden counter-irritant is needed. 



2. CAP'SICUM.— CAYEN'NE PEPPER. 



Of the employment of powdered capsicum and Tinctura Capsici, as 
rubefacient revellents, enough has been said when treating of capsicum 
as an excitant. (See Vol. i. 473.) 



^RUBEFACIENT REVELLENTS. — AMMONIiE PRiEPARATA. 249 



3. AL'LIUM — GARLIC. 

Garlic, by virtue of its acrid volatile oil — Oil of Garlic — is rubefa- 
cient; and the bruised cloves are sometimes applied to the feet in 
place of sinapisms, and with the same objects. A garlic poultice 
to the thumb is a popular revellent in toothache. It is rarely used, 
however, by reason of its very strong, and — to most persons — disagree- 
able odour. 

The same may be said of 4. Allium Cepa, the Onion; and 5. Al- 
lium Porrum, the Leek; the bulbs of which, by virtue of their acrid 
principle, are rubefacient also. 

6. AMMCNI-flS PRiEPARA'TA.— PREPARATIONS OF AMMO'NIA. 

All the preparations of ammonia are rubefacient ; but Liquor Ammo- 
nix is the one most frequently had recourse to. Under the head of 
Excitants it was stated, that ammoniated lotions had been highly ex- 
tolled as revellents in recent times; and the modes of forming those 
of Granville, and the Pommade Ammoniacale of Gondret were given. 
(Vol. i. p. 501.) All these are powerful agents: in their strongest 
form, they give rise, in a short time, to rubefaction and vesication over 
the whole surface to which they are applied ; almost as rapidly, indeed, 
as if boiling water were applied to the part. Their strength, may, 
however, be regulated so as produce either full vesication or simple 
rubefaction, by varying the proportion of liquor ammoniae. The mode 
of applying the ammoniated lotions is to impregnate a piece of cotton 
or linen, folded six or seven times with them,- or a piece of thick and 
coarse flannel, and then place either of these on the spot to be acted 
upon, pressing the hand, at the same time, very steadily and firmly on 
the compress, over which there should be placed a thick towel, doubled 
several times, so that not only the evaporation of the lotion may be im- 
peded, but the hand employed in pressing the application on the part 
may not suffer from direct or indirect contact with the liquid. Care 
must be taken, that the ammonia does not reach the eyes or nose. 

As a general rule, the application ought not to be kept on longer than 
from one to six or eight minutes; and, sometimes, the good effects 
supervene in less than a minute ; but, to excite the higher degrees of 
counter-irritation — as vesication and cauterization— as many as ten or 
twelve minutes may be necessary. 

It is chiefly in neuralgic diseases, that the benefit of these rapid coun- 
ter-irritants is most marked. The author has often employed them both 
in public and private practice ; and in nervous and spasmodic diseases, 
and neuralgic and deep-seated rheumatic affections, the benefit has often 
been most signal. Severe pains have yielded rapidly; hyperaemise of 
particular organs have been diverted elsewhere, especially when blood- 
letting, and other sedatives had been premised ; and in short, whenever 
revellents, sudden and rapid in their action, have been demanded, the 
ammoniated counter-irritants have effected everything that similar pow- 
erful revellents were capable of accomplishing; but no more. There 



^ 

r 



250 SPECIAL REVELLENTS. 

is an objection, however, that applies to these potent lotions, — that they 
are apt to occasion sloughs and sores, which are often considerable, 
and remarkably difficult to heal. This, it is true, may be partly pre- 
vented, by being careful, that the application is not too long continued; 
but, with the greatest caution, these results will supervene at times. 
When such is the case, simple dressings with emollient poultices will 
be found the best applications. 

LINIMEN'TUM AMMONIA, LINIMENT OF AMMO'NIA. (Liq. ammon. f.gj ; 
01. oliv. f.^ij-) This saponaceous liniment, of which hartshorn and 
oil is a variety, is often employed as a revellent in sore throat, as well 
as in lumbago, sciatica, and every form of rheumatic and neuralgic 
pain. It may either be rubbed on the part, — or a flannel, soaked with 
it, may be retained on the part of the cutaneous surface, which it is de- 
sired to irritate. 

7. CAN'THARIS.— SPANISH FLIES. 

Cantharides — whose properties as an internal remedy have been de- 
scribed elsewhere, (Vol. i. p. 281,) are chiefly used to induce vesica- 
tion ; but they are employed, likewise, as rubefacients. The author 
has, indeed, remarked, that when they induce vesication, the fluid, ab- 
stracted from the cutaneous vessels, can scarcely be regarded as exert- 
ing much, if any, agency ; and that the whole therapeutical influence 
would seem to consist in the rubefaction. Accordingly, a common 
object of the practitioner in the application of blisters is to induce redv 
ness of the surface ; and, as soon as this is accomplished, to remove 
the blistering plaster; but even then vesication frequently results, in 
consequence of the impression which has already been made on the 
secretory vessels of the skin. 

When the blistering plaster is applied to excite rubefaction only, it 
ought not to be kept on more than an hour or two. It is impossible to 
fix upon the exact time, as this may depend upon difference in the 
thickness of skin ; varying strength of the plaster, &c, and therefore, 
the best plan is to raise the plaster gently, and remove it on the first 
appearance of redness ; after which, a bread and milk poultice, or 
lint spread with cerate, may be applied. A common rubefacient lini- 
ment is made of tincture of cantharides mixed with soap or camphor 
liniment, (Tinct. cantharid. f.5ss ; Liriim. camphora, seu Tinctura sapo- 
nis camphorat. f.5iss.) 

LINIMEN'TUM CANTHAR'IDIS, LINIMENT OF SPANISH FLIES. {Cantharid. 
pulv. 3g ; 01. terebinth. Oss.) Oil of turpentine dissolves the can- 
tharidin, and the solution is a powerful irritant. It will generally 
excite rapid vesication ; and requires to be reduced by the addition 
of olive or linseed oil, when the object is merely to excite rube- 
faction. 

8. OL'EUM TEREBIN'THIN^E.— OIL OF TUR'PENTINE. , 

Oil of turpentine — whose general properties have been described 
already, (Vol. i. p. 481,) is % a powerful local excitant, and is used as a 



RUBEFACIENT REVELLENTS. — PIX ABIETIS. 



251 



rubefacient in many diseases. In long protracted fevers of an adynamic 
kind, it is rubbed, hot or cold, on the extremities, partly with the view 
of arousing the organic actions, and partly of localising a disease which 
is general. As a local rubefacient, it is employed in cases of deep-seated 
neuralgic and rheumatic affections of a chronic kind ; and in sore 
throat and other internal inflammations. Applied hot, it has been used ' 
as a rubefacient to the abdomen in malignant puerperal peritonitis. It 
is considered to be the chief ingredient in Whitehead's essence of mus- 
tard ; and the celebrated Liniment of St. John Long is said to have 
consisted of oil of turpentine and acetic acid suspended by yolk 
of egg. 

IMMEN'TUM TEREBINTH'INJl, Lffl'IMENT OF TURTENTINE. (Vol. i. p. 483.) 
This may be employed in rheumatic and other affections, in which it is 
desirable to produce a rubefacient effect. 

Oil of turpentine enters into the composition of Linimentum canthct' 
ridis, of the Pharmacopoeia of the United States. 

9. OL'EUM CAJUPU'TI — CAJ'EPUT OIL. 



Cajeput or Kyapootie oil, (Vol. i. p. 488,) has been used, mixed 
with an equal quantity of olive 

oil, as a rubefacient liniment, Fi s* 159 - 

in chronic rheumatic and neu- 
ralgic affections. It does not 
appear, however, to possess 
any virtues that do not equally 
belong to other essential oils ; 
all of which, by the way, are 
rubefacient revellents ; yet few 
are used as such, in conse- 
quence of their high price. 

10. PIX ABIE'TIS.— BUR'GUNDY 
PITCH. 

Burgundy pitch is the pre- 
pared concrete juice of Mies 
excelsa, Pinus Jibies, Norway 
Spruce Fir; Sex. Syst. Monce- 
cia Monadelphia ; Nat. Ord. 
Coniferae ; which is a native of 
Germany, Russia, Norway, 
and other parts of Europe ; 
and also of the northern parts 
of Asia. It is cultivated in 
England, flowering in May 
and June. It yields, by spon- 
taneous exudation, Common Abies excelsa - 
Frankincense— Abietis Resina of the London Pharmacopoeia,— Thus, of 




252 SPECIAL REVELLENTS. 

the Dublin. From this, Burgundy pitch is prepared by melting in hot 
water, and straining through a coarse cloth, by which the volatile oil 
and impurities are separated. ., According to Dr. Pereira, the substance 
sold in the shops as Burgundy pitch is rarely prepared in this way; but 
is fictitious, the principal constituent being resin, rendered opaque by 
incorporation with water, and coloured by palm oil. One fabricator of 
it informed him that he prepared it from old and concrete American 
turpentine. 

Burgundy pitch is hard, brittle, opaque, of a yellowish white colour, 
and of a wreak taste and smell of turpentine. When applied to the skin 
it adheres strongly ; and therefore forms an excellent material for a rube- 
facient plaster. Its chief constituent is resin, which is associated with 
a small quantity of volatile oil. 

Spread upon leather, Burgundy pitch is used as a plaster, — under the 
names Burgundy Pitch Plaster or Pitch Plaster. A margin should be 
left on the leather free from the pitch, otherwise it will adhere to the 
clothes, and subject the patient to much inconvenience. It is used in 
various chronic affections of the chest and abdomen, and in cases of 
chronic rheumatic or neuralgic affections, where a plaster is applicable. 
It almost always excites more or less irritation of the surface, which 
may be limited to simple rubefaction ; but at times extends to vesica- 
tion, and even to ulceration, -si 

EMPLAS'TRUM PICIS CUM CANTHAR'IDE, PLASTER OF PITCH WITH SPANISH FLIES, 
Emplastrum calefaciens, Warming Plaster , Warm Plaster. (Picis 
abiet. ggiiiss ; Cerat. cantharid. figss.) This is an excellent rubefacient 
plaster, but cannot be borne by many individuals. For such the pro- 
portion of flies may have to be diminished ; or they may not be tole- 
rated in any proportion. It is adapted for all cases in which a rubefa- 
cient plaster is indicated. 

Burgundy pitch enters into the composition of Emplastrum Galbani 
Composition of the Pharmacopoeia of the United States. 

11. PIX CANADENSIS.— CAN'ADA PITCH, HEMLOCK PITCH. 

Hemlock Pitch is the prepared concrete juice of Mies Canadensis, 
Pinus Canadensis, Hemlock Spruce, a tree which flouiishes in the 
British northern provinces, and in the more northern parts of New Eng- 
land, as well as in mountainous regions in the Middle States. The 
pitch exudes spontaneously from the full grown trees; and concretes 
on the bark. This is removed from the tree, broken into pieces, and 
boiled in water. The pitch rises to the surface, whence it may be 
removed, and purified by a second boiling. It may be freed from its 
impurities by melting, and straining through coarse linen or canvas. 

Canada pitch, hemlock pitch, hemlock gum, as met with in the shops, 
is hard, brittle and opaque, like Burgundy pitch ; of a dark yellowish- 
brown colour, and peculiar smell. When made into a plaster, it is a 



RUBEFACIENT REVELLENTS. — DRY CUPPING. 253 

mild rubefacient, resembling, in its properties, Burgundy pitch; for 
which it may be substituted. 

12. CALOR'IC. 

Heat, when applied to any part of the cutaneous surface, may be 
regulated so as to act as a rubefacient revellent. Thus, hot water, be- 
tween 120° and 150° Fahr., operates in this manner ; and hence, pedi- 
luvia and cataplasms exert an unquestioned revellent agency in many 
cases of internal inflammation. Occasionally, other rubefacients are 
added ; as when we stir flour of mustard in the water of a common 
foot-bath, or add it to a cataplasm. Hot fomentations act upon the 
same principle in the relief of internal and deep-seated pains, of a neu- 
rapathic character especially. 

13. FRICTIONS. 

Frictions, when properly employed, are excellent revellents, produ- 
cing, if employed for a sufficient length of time, redness of the surface. 
It is mainly by virtue of the friction that several of the liniments exert 
their beneficial agency in many morbid conditions. This is proved by 
the fact, that astonishing relief is afforded by dry rubbing. The use of 
the curry-comb, it is universally admitted, has an excellent effect on 
the nutrition of the horse ; and the flesh-brush, or rubbing the whole of 
the surface of the body with gloves made of horse-hair or a coarse 
towel, has a no less beneficial agency in many morbid cases, — of torpor 
of the digestive function especially. Friction with the dry hand, exe- 
cuted for at least half an hour by the clock, is an excellent agent in 
many rheumatic and neuralgic affections ; but it must be faithfully em- 
ployed, and for a fixed period, to reap much benefit from it. When 
thus used, it has afforded marked relief in deep-seated pains, after lini- 
ments, rubbed in for a short time, had been used in vain. The only 
precaution necessary is for the rubber to dip his hand every now and 
then into wheaten flour or rye meal, which prevents abrasion either of 
the rubber or the rubbed. 

14. DRY CUPPING. 

Under the general observations on revellents, the derivative effect of 
local blood-letting by cupping was examined. This effect was consi- 
dered to be induced by the compound action of the loss of blood from 
the divided capillaries, and the wounds made by the scarificator; and 
— it may be added — from the diminished atmospheric pressure on the 
part to which the cupping glass is applied. When dry cupping is em- 
ployed, the last is the main revulsive influence exerted. Yet it is a very 
valuable one in many cases, and well adapted for the relief of local 
pains, especially in those persons who, from protracted indisposition, or 
other causes, are unable to bear cupping with the scarificator, or what 
are commonly called cut cups. An air-pump bath has been employed, 
in which the atmospheric pressure is diminished over a greater or less 
surface of the body ; and the application of vapour has been associated 



254 SPECIAL REVELLENTS. 

with this, constituting the air-pump vapour bath, which has been used 
in gout, rheumatism, and paralysis. Hcemospasia — as this mode of re- 
vulsion has been termed — was first urged some years ago by M. Junod, 
who twice received the Monthyon prize for his essays on the subject. 
It has been properly described as a means of producing a powerful 
revulsion of the blood from one part, and an equally powerful direction 
of it to another part of the body, by removing the atmospheric pressure 
from a large extent of surface, — as from one or both extremities at the 
same time. It is, in other words, dry cupping on a large scale. In 
1835, M. Magendie highly extolled it in cases in which it is important 
to attract the blood from the internal parts towards the surface of the 
body, without causing any loss of the vital fluid ; and its effects certainly 
entitle it to great attention. They resemble those produced by hsemos- 
tasis, which — as elsewhere remarked — detains the blood in the vessels 
of the surface, and thus acts, for the time, in the same manner as the 
withdrawal of a certain quantity of blood from the circulation. The 
face, under the haemospastic treatment, is rendered pale ; the pulse 
slower; at times, there is a tendency to syncope; and often much dis- 
turbance of the gastric and intestinal functions. In inflammatory dis- 
eases it may be employed under the same circumstances ashsemostasis; 
and in addition, "in affections of internal organs, which require the use 
of an efficacious and powerfully revellent influence. 

M. Junod's apparatus, is made of copper in the shape of a boot, and 
is applied as one, having an India rubber top to tie round the thigh, and 
render it air-tight. The air is then exhausted by means of a syringe. 
By the application of this apparatus, the leg may be distended to double 
its ordinary size ; the pulse is at first quickened, but is gradually re- 
duced both in frequency and strength, and even syncope may super- 
vene. Very little pain attends the operation. After the removal of the 
apparatus, the blood gradually returns to its course ; and in a couple of 
hours the swelling of the leg subsides. Experience has shown, that 
sixty operations on the same leg, with one or two days interval, may 
be attended with no injurious effects to the nervous system. Dr. 
Marsden described to the Provincial Medical and Surgical Association 
an establishment under the superintendence of M. Bonnard, of Paris, 
which was entirely devoted to the application of this instrument. He 
referred to the success which had attended its employment by M. 
Cerise, and detailed the histories of several cases in which he had 
himself witnessed beneficial results, — as in amaurosis, deafness, sore- 
throat, chlorosis, amenorrhcea, croup, phthisis, &c. — a somewhat hetero- 
geneous assemblage ! (New Remedies, 5th edit., p. 618, Phil., 1846.) 

It need scarcely be said, that the diminished pressure induced over 
a considerable surface must necessarily have the effect of modifying the 
circulation of the blood, and inducing a new effect on the nervous sys- 
tem ; and hence it may be an energetic revellent. 

15. AC'IDUM ACE'TICUM.— ACETIC ACID. 

Strong acetic acid — described under Escharotic Revellents — is era- 
ployed as a rubefacient. It may be diluted with an equal quantity of 



RUBEFACIENT REVELLENTS. — MAGNETISM. 255 

water; and a piece of cotton, or blotting paper, clipped in it, may be 
left on the skin, until the effect is induced. In its concentrated state it 
may be applied in the same manner to cause vesication, and if kept on 
for a long time may disorganize the integument so as to induce slough- 
ing. It has been used in cases of cramp, and other affections, in which 
it is esteemed advisable to induce sudden revulsion ; but it is rarely 
had recourse to. 

16. AC'IDUM NI'TRICUM.— NITRIC ACID. 

Nitric acid, (Vol. ii. p. 73,) rubbed on the skin, is capable of ex- 
citing rubefaction, where it is desirable to induce a speedy action on 
the cutaneous surface, as in malignant cholera. For this purpose it 
may be diluted with six or eight parts of water. In its concentrated 
state, it acts of course more violently ; but it is not preferable, as a 
counter-irritant, to boiling water ; whilst its destructive action on every 
organic substance with which it comes in contact makes it objection- 
able. It is rarely used as a rubefacient. 

The Dublin College has Unguentum Acidi Nitrici, which is com- 
posed of Olive oil fgj ; Lard ^iv ; Nitric acid f.5vss; which may be 
rubbed on the skin to excite rubefaction. 

17. AC'IDUM SULPHU'RICUM.— SULPH'URIC ACID. 

Sulphuric acid may be used like the nitric to produce a rubefacient 
action. The Dublin College has a formula for Unguentum Acidi Sul- 
phurici, which is composed of Sulphuric acid 3j ; Lard 3j. It is used 
in the same cases as Unguentum Jicidi Nitrici. 

18. Acupuncture, Electropuncture, Electricity, Galvanism, 
&c, considered under Excitants, (Vol. i. p. 510, et seq.) act as revel- 
lents. And the same may be said of 

19. Magnetism. It has been affirmed by Baron Von Reichenbach, 
that magnets of ten pounds supporting power, when drawn along the 
body downwards, without contact, produce certain sensations in sensi- 
tive individuals. Occasionally, in twenty persons, three or four sus- 
ceptible persons are found ; and in one examination by Von Reichenbach 
of twenty-two females, eighteen were susceptible. The sensation is 
said to be rather unpleasant than agreeable, and is like an aura, in 
some cases warm ; in others cool ; or it may be a feeling of pricking, 
or of the creeping of insects over the skin. Persons affected with spas- 
modic diseases— epilepsy, catalepsy, chorea, paralysis and hysteria- 
are especially sensitive ; and lunatics and somnambulists uniformly so. 

Under such circumstances, the diseases for which magnetism would 
be suggested, are the "nervous and spasmodic;" and accordingly the 
report of the Societe royah de medecine of Paris, in 1776, testified to its 
success in spasms, palpitations, convulsions, epilepsy, tremors, cramps, 
neuralgia, rheumatism, &c. ; and MM. Andry and Thouret, were dis- 



256 SPECIAL REVELLENTS. 

posed to infer, that the magnet exerts an incontestable magnetic action 
on the nervous system, to which, in part at least, its curative agency 
must be ascribed. M. Laennec, too, by establishing a magnetic current 
through the diseased parts by means of several magnetized plates, fre- 
quently found the pain moderated in pulmonary neuralgia; the oppres- 
sion diminished in nervous asthma; spasmodic hiccough suspended; 
and its utility exhibited in simple neuralgia of the heart, and in angina 
pectoris. In the last disease, the application of a small blister under 
the anterior plate appeared to render the effects of the magnet more 
marked. 

The author has witnessed the application of the magnet repeatedly in 
nervous diseases in persons of highly impressible habits ; but except in 
such, and apart from the effects of the imagination, he has seen no bene- 
ficial results from it. (New Remedies, 5th edit. p. 429, Philad. 1846.) 

It is needless, therefore, to enter into a detail of the different modes 
of application. 

b. Vesicant Revellents. 

20. CAN'THARIS.— SPANISH FLIES. 

The employment of cantharides as a rubefacient revellent has already 
been described, (ii. 250). They are most commonly used, however, as 
vesicants: indeed, they are the only agents employed with this view by 
the mass of practitioners ; and with the exception of cases in which the 
irritation produced by them is excessive, they are the best of the vesi- 
cants that require time for their operation. 

The general properties of cantharides have been described elsewhere, 
(Vol. i. p. 281.) It was there mentioned, that their active property 
resides in a peculiar principle, cantharidin. This has been found, like- 
wise, in cantharis vittata, and other vesicating insects. It is obtained 
by concentrating an alcoholic tincture of the flies, made by displace- 
ment, and setting it aside. The cantharidin crystallizes slowly. It is 
considered to be a solid volatile oil. It is not, of itself, soluble in 
water; but becomes so by combination with other constituents of can- 
tharides. It is easily dissolved in ether; and in oils— fixed and volatile 
— as well as in hot alcohol. One hundredth part of a grain, placed on 
a slip of paper, and applied by M. Robiquet to the edge of the lower 
lip, caused small blisters in a quarter of an hour. Its action as a vesi- 
cant is exceedingly energetic. 

Powdered cantharides yield their vesicating properties to boiling 
water, and more readily to acetic acid, alcohol, dilute alcohol, ether, 
and the fixed and volatile oils ; all of which have, therefore, been used 
pharmaceutically, and most of them are employed at the present day in 
different officinal formula?. 

When applied to the cutaneous surface in a proper form, cantharides 
first induce rubefaction, as already shown, and then vesication. The 
length of time required to produce the latter effect varies in different 
individuals. The usual routine direction is to put on a blister at bed- 



VESICANT REVELLENTS. CANTHARIS. 257 

time, and to remove it the following morning. Where the skin, how- 
ever, is thin, vesication will be induced in a much shorter time — in 
six or eight hours. The blister should then be removed, as a longer 
continuance may induce so much irritation in the derma as to give 
occasion to sloughing ; or the cuticle may break, the effused fluid be 
discharged, and, owing to the vesicating substance coming in contact 
with the exposed derma, absorption of the cantharidin may occur en- 
dermically, and cause great nephritic and vesical distress. In children, 
it is extremely important to bear this in mind, as gangrene has super- 
vened on the application of blisters, especially where erethism has 
existed in the dermoid tissue, — as in cases of measles, scarlatina, &c. 
A few hours — three or four at the farthest — are commonly enough to 
excite rubefaction, if not vesication ; and if the former be fully de- 
veloped when the blister is removed, the latter is pretty sure to succeed 
under the use of simple cerate. When the blistering plaster is taken 
ofT", the blisters should be opened by snipping them with a pair of 
scissors, and applying a dressing of simple eerate, or of oil and wax 
melted together. In the Southern slates — the leaves of the common 
cabbage are used as a dressing. Of late, Dr. D. Maclagan, has re- 
commended that blistered surfaces should be dressed with cotton wad- 
ding. After a blister has been removed, he applies for two hours a 
soft warm poultice of bread and milk. When the poultice has been 
removed, the vesication, if it has not burst spontaneously, must be cut, 
and a thick layer of soft cotton wadding be applied with the undressed 
or woolly surface next the skin. If, in the course of a few hours, this 
should become soaked with the serous discharge from the blister, so 
much of the cotton may be removed as can be done without disturbing 
the loose epidermis beneath, and the whole must be again covered 
with a dry layer of cotton. This is all the dressing that is in general 
required. The cotton is allowed to adhere to the skin of the blistered 
part, and when a fresh layer of epidermis is formed, the old epidermis 
and cotton come off together. 

The advantage of this plan, Dr. Maclagan states to be:— -first, that 
it renders the blister much less painful and annoying to the patient than 
when ointments are used. The tenderness in fact is comparatively so 
trifling, and the protection by the cotton so good, that he has been 
enabled, without annoyance to the patient, to percuss freely, and apply 
the stethoscope firmly over blistered parts, which had been dressed for 
the first time only an hour or two previously. — Secondly. The blisters 
heal faster under it than under dressings with cerate ; for although the 
cotton may remain adhering for some days, he has generally found that 
within twelve hours the patient ceases to consider the blister a source 
of annoyance : — and Lastly. It dispenses with the greasy applications 
so disagreeable to patients of cleanly habits. 

Generally, the blistered part heals in the course of a few days, but 
at times, suppuration follows. Occasionally, the skin is so little sen- 
sible, that blisters do not affect it, unless the surface has been first irri- 
tated by rubbing it with oil of turpentine, or by the application of a 
sinapism. 

It has been before stated, that to prevent the absorption of cantha- 

Voi.. II.— 17 






258 * SPECIAL REVELLENTS. 

ridin, and its irritating effects on the urinary organs, a piece of gauze or 
tissue paper should be placed over the blistering plaster, through which 
the vesicating property is sufficiently exerted. It is said, that by boiling 
the flies in water, their power of causing strangury is destroyed; whilst 
the vesicating property is unimpaired. When those effects have been 
induced, the best remedies are diluents and opiates. Owing to the lia* 
bility to these painful accidents, especial caution should be used in the 
employment of blisters of cantharides in inflammatory affections of the 
urinary apparatus. 

CERATUM CANTHARIDIS, CERATE OF SPANM FLIES, (Cantharid. pulv. 
subtiliss. fgj ; Cera flavce, Resin., Adipis aa. § viij.) This is Emplas- 
trum epispasticum, Blistering Plaster, of the shops. When used, it is 
generally spread upon leather, a margin being left to prevent the plaster 
coming in contact with the clothes of the patient; or the margin is 
spread with Emplastrum plumbi, or Emplastrum resince, to cause it to 
adhere. In eleemosynary institutions, it is generally extended upon 
coarse paper. The use of sheepskin has been objected to by Mr. Wm. 
Procter, junr., of Philadelphia, and with propriety, as, owing to its po- 
rous character, it absorbs much of the vehicle, and sometimes leaves 
the surface of the plaster so dry, that its adherence and activity are pre- 
vented. The material should be soft and yielding, at the same time 
that it ought not to absorb the oil from the cerate ; and, accordingly, 
oiled silk, which possesses all these requisites, has been proposed as a 
substitute for sheepskin. 

When it is desired that the blister should heal speedily, it may be 
dressed with simple cerate, in the manner before mentioned. At times, 
however, the surface becomes exceedingly red and inflamed, and -the 
margin is covered with an ecthymatous eruption : at others, a kind of 
diphtheritic exudation accompanies the vivid inflammation. In such 
cases, an emollient poultice may be demanded, with the ordinary treat- 
ment required in inflammation of the skin. When the surface remains 
red without any disposition to heal, dusting with hair powder, or with 
chalk, has sometimes a salutary effect; and if the granulations be too 
luxuriant, it may be necessary to touch the surface with sulphate of 
copper, and dress it with dry lint. Occasionally, it is considered de- 
sirable to keep the blister open, or to form what is called a "perpetual 
blister." This may be effected by dressing it with Ceratum resina, 
Ceratum sabince, or Unguentum cantharidis. 

The Edinburgh College has Emplastrum cantharidis compositum, 
(Tereb. Vend. sjvss; Picis Burgund., Cantharid. aa liij ; Cerse, 5j; 
Cupri subacetat. ^ss ; Sinap. alb., Piperis, aa 3ij) which is said to be 
an infallible vesicant. It is an unnecessary polypharmacal addition to 
the list. 

The London and Edinburgh Pharmacopoeias have Jicetum cantharidis 
or Vinegar of cantharides, (Cantharid. pulv. 3ij ; Acid, acetic. Oj.— 
Pharm. Lond.) which resembles the chemical blistering fluid, recom- 
mended by Messrs. Pugh & Plews, of Edinburgh, several years ago. 
A piece of lint, wetted with this preparation, may be placed upon the 
part, and be covered by adhesive plaster. It is said to vesicate in the 



VESICANT REVELLENTS.— ARGENTI NITRAS. 259 

course of three hours ; and not to induce strangury. It would appear, 
however, to be somewhat uncertain in its operation. 

An ethereal extract of cantharides, melted with twice its weight of 
wax, and spread upon cloth or paper prepared with waxed plaster, has 
been employed as a blistering cloth, and substituted for ordinary blister- 
ing plaster. A blistering paper has likewise been made by spreading 
upon paper an ointment, composed of white wax 8 parts ; spermaceti 
3 parts ; olive oil 4 parts ; turpentine 1 part ; cantharides, in powder, 1 
part ; water 10 parts. This is boiled slowly and strained. (Henry and 
Guibourt.) 

A solution of cantharidin in olive oil has been proposed as a sub- 
stitute for ordinary blistering plaster, — paper being saturated with it ; 
but it is not much used. 

Can'tharis Vitta'ta, Polato flies, (Vol. i. p. 283,) may be used as 
a substitute for Cantharis. 

21. AMMCNIiE PR^PARA'TA.— PREPARATIONS OF AMMO'NIA. 

Enough has already been said of the use of these as vesicants, under 
the head of Rubefacient Revellents. (Vol. ii. p. 249.) 

22. ARGENTI NITRAS.— NITRATE OF SILVER. 

Nitrate of silver is most frequently employed as an escharotic ; but it 
is likewise used occasionally as a vesicant. With this view, the partis 
moistened, and the solid nitrate is passed lightly over it in a crucial 
direction, so that the whole of the moistened surface may be affected, 
and yet not to the extent of inducing ulceration. In three or four 
hours, the epidermis rises, the subjacent fluid being rather purulent 
than serous ; this may be discharged, and if any dressing be needed, 
it may be of Ceratum simplex. Dr. A. T. Thomson affirms, that he 
has found this mode of exciting vesication admirably adapted for pul- 
monary affections attended with much morbid excitement. Twenty of 
these blisters may be made over the surface of the thorax, in as many 
days, with the best effects. It is equally useful, he adds, in diseases of 
the joints, and deep-seated pains. " The only caution required is mode- 
ration in the application ; when too much of the nitrate is rubbed on 
the part, the pain is excruciating, and its influence on the vascular sys- 
tem is sufficient to counteract any benefit which might result from its 
contra-stimulant property." 

It has been strongly recommended as an application in external in- 
flammation ; applied, at times, so as merely to blacken the surface ; at 
others, so as to excite vesication ; and the new action thus induced in 
the vessels of the part— as elsewhere remarked of blisters, (Vol. i. p. »v\ 
440,)— is sufficient at times to arrest erysipelas, and occasionally phleg- 
monous inflammation also. It is not uncommon to trace a line around the 
inflamed parts with stick nitrate of silver, with the view of circumscribing 
the inflammation ; and the artificial excitement of the capillaries, thus in- 



260 



SPECIAL REVELLENTS. 



Fig. 160. 



duced, is at times effectual in limiting the disease; but it has often 
failed in the author's practice ; as it has in that of others. 

23. RANUN'CULUS.— CROWFOOT. 

Ranunculus— in the secondary list of the Pharmacopoeia of the United 
States— is the cormus and herb of Ranunculus bulbosus, Crowfoot 
Buttercup, Yellow weed; Sex. Syst. Polyandria Polygyria; Nat. Ord! 

Ranunculaceae ; which is common in the 
pastures of the United States, flowering in 
May and June. All the ranunculi are 
possessed of an acrid principle, which 
passes over in distillation with water, and 
is lost by the process of drying. 

Ranunculus, when bruised and applied 
to any part of the cutaneous surface, ex- 
cites redness; and if kept on for any 
length of time, generally induces vesica- 
tion ; but it appears to be exceedingly 
uncertain in its operation ; sometimes pro- 
ducing scarcely any effect ; at others, caus- 
ing ulceration and sloughing of the integu- 
ment. It is, consequently, but little used. 

24. SINA'PIS.— MUSTARD. 

Enough has been said of the vesicating 
action of mustard, and its essential oil, 
under Rubefacient Revellents, (Vol. ii. p. 
247,) to which the reader is referred. 

25. CALOR'IC. 



Vesication can be effected by the appli- 
cation Of STEAM, Or BOILING WATER, Or 

heated metal. Steam is very rarely 
used therapeutically, in consequence of 
Ranunculus acm. the difficulty of restricting its action to a 

part of the surface ; t and the same applies, 
to a great extent^ to the application of boiling water. By the use of 
heated metal, this inconvenience can be avoided. The mode of apply- 
ing it is by means of a piece of polished metal, dipped in boiling water, 
and applied to the part to be vesicated. These agents induce sudden 
revulsion, and are adapted for violent affections, such as spasm of the 
stomach, or severe neuralgic affections of any kind. 

A plan, lately proposed for raising vesications on the surface, is very 
effective ; and has been regarded as a form of moxa. It is attended 
with intense pain ; but in severe cases this may be far from objection- 
able. A piece of linen or paper, cut of the requisite size, is immersed 
in spirit of wine or brandy. It is laid on the part to be blistered, care 
being taken that the moisture from the paper or linen does not wet the 




SUPPURANT REVELLENTS. — UNGUENTUM ANTIMONII. 261 

surrounding surface. The flame of a lighted taper is then applied 
quickly over the surface, so as to produce a general ignition, which is 
exceedingly rapid. At the conclusion of this operation, the cuticle is 
found detached from the true skin beneath. 



c. Suppurant Revellents. 

26. ANTIMO'NII ET POTAS'S^E TARTRAS.— TARTRATE OF ANT'IMONY AND 

POTAS'SA. 

Tartrate of antimony and potassa, associated with lard and rubbed 
on the skin night and morning, inflames the derma and gives occasion 
to a crop of large pustules with inflamed bases. It is sometimes used 
in the form of solution, which is rubbed on the part; and in other cases, 
from ten grains to a drachm in fine powder are sprinkled over a Bur- 
gundy pitch plaster. The effect is the same from these different forms 
of application. When the pustules have once appeared, it should be 
discontinued, for fear that troublesome ulcerations may ensue. Tar- 
trate of antimony and potassa, in the form of ointment, has been used, 
likewise, to keep issues open; but caution is here again required, lest 
extensive ulceration or sloughing should be induced. In the last case, 
too, danger is incurred of absorption of the salt, which sometimes fol- 
lows the other modes of employing it ; but such absorption is rare.-^ 

Pustules produced by the ointment of tartrate of antimony and po- 
tassa are generally exceedingly painful ; but they are well adapted for 
establishing effective counter-irritation in chronic pulmonary, and other 
internal diseases. It is well to bear in mind, that the large pustules 
are often succeeded by white scars, so that the salt should not be ap- 
plied to parts of the surface that are apt to be exposed. 

.UNGUEN'TUM ANTIMO'NII, ANTIMO'NIAL OINTMENT. (Antim. et Potass. 
Tartrat. in pulv. subtiliss. 3ij ; Adipis 3j.) A portion of this ointment 
of the size of a hazelnut, may be rubbed on the skin night and morn- 
ing: in the course of a day or two, the part generally becomes painful, 
and a crop of pustules appears: the rubbing may then be discontinued, 
and a fresh portion of skin be selected ; so that, in this way, a succes- 
sion of irritations may be maintained. The facility with which the 
eruption can be produced depends upon the thickness and impressi- 
bility of the skin : at times, the author has found the advent of the pus- 
tules hastened by the previous application of a sinapism. The oinfment 
should not be applied over an abraded or cut surface. Instances have 
been related in which severe and even fatal constitutional disorder has 
appeared to result from the use of antimonial ointment ; but the author 
has never met with a serious case. In two or three persons, it has 
excited vomiting. 

Tartrate of antimony and potassa may likewise — as remarked above — 
be used in the form of lotion, in the proportion of one drachm of the 
tartrate to a fluidounce of boiling water, rubbed together in a mortar. 



262 SPECIAL REV ELLEN TS. 

It is often employed in pulmonary affections, rubbed on the chest night 
and morning. Dr. Hannay adds five grains of corrosive chloride of 
mercury, by which, he says, the power and efficacy of the lotion are 
quickened. 

27. IPECACUAN'HA. 

A counter-irritant of powdered Ipecacuanha has been recommended 
by Dr. Hannay, which, he says, was first suggested to him by his 
colleague, Dr. Easton, Professor of Materia Medica in Anderson's 
University, Glasgow. It is composed of Ipecacuanha powder, and olive 
oil, of each two drachms; lard, half an ounce. The part is to be 
rubbed freely with this liniment for fifteen or twenty minutes, three or 
four times daily ; and to be enveloped in flannel. In about 36 hours, 
or sometimes sooner, very numerous small papulae and vesicles appear, 
seated on a deep red base of irregular extent. These soon become 
flattened and assume the pustular character. They never ulcerate like 
pustules produced by tartrate of antimony and potassa, than which ipe- 
cacuanha is much less severe ; but not less efficacious. 

The author has never employed this counter-irritant, and notwith- 
standing the encomiums of Dr. Hannay the experience of others does 
not encourage him. Dr. Cormack detailed to the Medico-Chirurgi- 
cal Society of Edinburgh, the result of his hospital observations with 
it in the form advised by Dr. Hannay. In ten out of twelve cases, 
it failed to produce any eruption, even when the powder was in the 
proportion of half an ounce to an ounce of lard. In a few persons 
only, who had delicate skins, or had had recent blisters on the surface 
experimented on, he succeeded in bringing out an eruption, which was 
vesicular in three carefully observed instances. In the persons on whose 
skin the ointment of ipecacuanha produced no effect, a good crop of 
pustules was, in every case, brought out by one, two or three frictions 
with a liniment of equal parts of olive and croton oil. Dr. Cormack 
expressed the belief, that there are many vegetable powders, which 
would be found more active counter-irritants than ipecacuanha. 

The experience of Dr. Cormack was corroborated by that of other 
physicians, who were present at the meeting of the society. The au- 
thor has never used it. 

28. CLEUM TIG'LII.— CROTON OIL. 

Croton oil — whose general properties have been described under 
Catlfartics, (Vol. i. p. 204,) — rubbed upon the skin, excites redness, 
followed by an eruption of pustules, provided the friction be long con- 
tinued, or often repeated. These pustules, when numerous, become 
confluent, and around the place where the confluent eruption is seated, 
pimples appear over a wider extent, which become transformed into 
pustules, and are surrounded by a red base or areola. When the pus- 
tules are discrete, they dry up more rapidly; and when confluent usu- 
ally form scabs. As in the case of antimonial ointment, the pustulation 
is sooner induced where the skin is thin. Commonly, the eruption is 



SUPPURANT REVELLENTS. — ISSUES AND SETONS. 263 

perceptible within twelve hours after the first friction, if it has been 
continued for some minutes; and it usually disappears in the course of 
from three to six days. It is never so painful as that caused by anti- 
monial ointment. 

Frictions with the oil are adapted for cases in which counter-irritants, 
that require time to induce their action, are indicated It has been 
much used in chronic internal inflammations, in gouty and rheumatic 
affections, aphonia, chronic hoarseness, phthisis, asthma, and hooping- 
cough ; and has been regarded as especially effective in rheumatic 
odontalgia and otalgia. 

When applied with the view of exciting an eruption, — from four to 
six drops, or even more, may be rubbed in twice a day. Generally, a 
mixture of equal parts of the oil and olive oil is sufficiently powerful. 
If the skin be thick, it may be well to rub it first with a coarse towel, 
or to apply a sinapism. Where the skin is excitable, it may be mixed 
with from one to five parts of olive oil, oil of turpentine, soap liniment, 
or lard. An ointment of a still feebler kind is sometimes used for the 
same purpose. (01. Tiglii, ^lx — xxx; Jjdipis §ss.) This is adapted 
for the delicate skins of children. 

M. Bouchardat has recommended the following plaster of croton oil. 
Melt eighty parts of diachylon plaster at a very gentle fire, and when 
serailiquid mix with it twenty parts of croton oil. The resulting plas- 
ter is to be spread thickly on muslin. It is capable of producing con- 
siderable irritation of the skin ; and may be employed in all cases 
where revellents are required. It does not occasion such severe pain as 
many other counter-irritants ; and, according to M. Bouchardat, it will 
be found available in the treatment of many chronic diseases of the 
thoracic and abdominal viscera. 

29. AC'IDA MINERA'LIA.— MIN'ERAL ACIDS. 

Mineral acids — especially Sulphuric and Nitric — when combined 
with a greater quantity of lard than that mentioned under the head of 
Rubefacient Revellents, (Vol. ii. p. 255,) and rubbed for some time on 
any part of the cutaneous surface, give occasion to the formation of 
pustules, which may be the means of deriving from inflammatory and 
other irritation in internal organs. They are not, however, much em- 
ployed with this object. 

30. ISSUES AND SETONS. 

Issues — Fonticuli — may be made with any actual cauterant, or with 
any of the potential cauterants described hereafter. The most common 
agent is potassa ; and, when the slough has separated, either the Curagoa 
orange — Qurantium Curassaventium — or a common dried pea, is intro- 
duced, and kept in its place by diachylon or some form of adhesive 
issue plaster. Occasionally, to keep them discharging, it becomes 
necessary to apply one of the suppurant ointments already described. 

The seton — Setaceum — is established by pinching up the common 
integument of the part with the finger and thumb of the left hand ; and 



264 SPECIAL REVELLENTS. 

passing through it a seton needle, armed with a skein of silk ; or an 
ordinary tape, or a caoutchouc tape, or a strip of sheet lead may be used 
for the same purpose. The position of these must be changed daily 
and it may be necessary to smear them, from time to time, with some 
excitant ointment. 

Issues and setons are valuable counter-irritants; and, as already re 
marked, their good effects are not dependent upon the discharge hi 
upon revulsion. At the same time they are uncleanly and disagreeable 
require much attention; and are consequently by no means as often 
employed as they were formerly. It is difficult to induce patients to 
repeat the application of other counter-irritants as often as may be de 
sirable; and therefore the practitioner has recourse to permanent 
revel lents of this kind. The system, however, gradually becom 
accustomed to them, so that they, in some measure, lose their effect 
and by long continuance, become so much a part of the natural actions' 
that they cannot be suddenly arrested with impunity. When old ulcers 
heal, a source of irritation is apt to occur elsewhere ; and it becomes 
advisable to insert a seton, or to establish an issue in the vicinity For 
head aflections, the seton is usually placed in the nape of the neck- for 
phthisical cases in the side. It is a popular preference to establish an 
issue in the arm for ophthalmia. In spinal affections it is generally made 
on each side of the vertebral column. 

Dr. Golding Bird has recently proposed what he calls an Electric 
Moxa, founded upon the long observed fact, that when a simple galvanic 
arc is applied to a blistered surface, the part opposed to the most oxi- 
dizable metal is more irritated than that to which the negative plate is 
applied. In adapting such a simple arc to the treatment of paralysis, 
he was struck with the remarkable effects produced. The following he 
proposes as a ready mode of establishing a discharge from the surface 
of the body. Order two small blisters, the size of a shilling to be applied 
to any part of the body— one a few inches below the other; when the 
cuticle is thus raised by effused serum, snip it, and apply to the one, 
whence a permanent discharge is required, a piece of zinc foil, and to 
the other a piece of silver; connect them by a copper wire, and cover 
them with a common water dressing and oiled silk. If the zinc plate 
be raised in a few hours, the surface of the skin will look white, as if 
rubbed over with nitrate of silver. In forty-eight hours, a decided 
eschar will appear which, if , the plates be still kept on, will begin to 
separate at the edges in four or five days. The plates may then be re- 
moved and the surface where the silver was applied will be found com- 
pletely healed A common poultice may be applied to the part, and a 
healthy granulating sore, with well defined edges, freely discharging 
pus, will remain. J & 

31. CAN'THAMS.-SPANISH FLIES. 

Cantharides are employed in the form of ointment to keep blisters 
Dpen, and to excite suppuration. r 



SUPPURANT REVELLENTS. — MEZEREUM. 265 

UNGUEN'TUM CANTHAR'IDIS, OINTMENT OF SPANISH FLIES. {Cantharid. pulv. 
3ij ; Aqux destillat. Oss ; Cerat. resin. §viij.) The Spanish flies are 
boiled in the water and strained ; the cerate is then mixed, and the 
whole is properly evaporated. Boiling the flies in water does not destroy 
their peculiar powers ; but it has been considered by some that it ren- 
ders their active principle less liable to be absorbed. Spread on lint, 
this ointment is a very common and good application to blistered sur- 
faces to induce suppuration ; and to issues to keep them open ; and it 
may be used in cases of atonic ulcers to excite in them a new action. 

32. SABI'NA.— SAVINE. 

Savine — whose irritant qualities have been referred to elsewhere, 
(Vol. i. p. 419,) — is frequently employed as a suppurant to form per- 
petual blisters. With this view, it is made into a cerate, which in Eu- 
rope, is formed of the fresh leaves ; and is, therefore, more active ; but 
even there it is complained of for its uncertainty ; — perhaps, as sug- 
gested by Dr. Christison, owing to a part of the volatile oil — the active 
constituent — being driven off by the high heat directed in preparing it. 
In this country, savine cerate is prepared according to the following for- 
mula, from the drug as imported. 

CERA'TUM SABIM, SAVINE CERATE. (Sabin. pulv. §ij ; Cerat. resin. 
££j.) This cerate is to be preferred to Unguentum Cantharidis for one 
reason, — that there is no risk of strangury from absorption of acrid mat- r " L "- 
er. It is occasionally applied to the threads or tapes of setons, and to 
issues to increase the discharge. 

An ointment is sometimes prepared from Juniperus sabina, American 
savin, which is used for the same purpose. 

33. MEZE'REUM.— MEZE'REON. 

Mezereon — whose general properties are described in the first volume, 
(p. 321,) — is a local irritant and vesicant. The fresh bark is more ac- 
tive ; but the dried possesses the virtues. Both that of Daphne meze- 
reum and of Daphne gnidium, or gar ow, is employed. It may be soaked 
in hot vinegar and water, and be applied to the part by a compress and 
bandage. The application must be renewed night and morning, until 
it occasions vesication ; which generally requires from twenty-four to 
forty-eight hours. 

UNGUENTUM MEZE'REI, OINTMENT OF MEZE'REON- {Mezerei concis. §iv ; 
Adipis gxiv ; Cerse albce §ij. The mezereon is digested with the lard 
in a salt-water bath, according to the directions in the Pharmacopoeia. 
To the strained lard, the wax is added; and an ointment formed.) 
This ointment may be used to keep blisters and issues open. It has 
been introduced into the last edition of the Pharmacopoeia of the United 
States. 

An ointment has likewise been made of the alcoholic extract of meze- 
reon, which is employed for the same purposes. 



266 SPECIAL REVELLENTS. 

d. Escharotic Revcllents. 

1. Erodents. 
34. ARGEN'TI NITRAS.— NITRATE OF SILVER. 

As an erodent, nitrate of silver is applied, in the solid state, to fungous 
growths, warts, corns, &c, that possess feeble vitality; and are, there' 
fore, readily destroyed. When first brought in contact with luxuriant 
growths or an ulcer, it produces a w T hite film, which is owing to the 
combination of the nitrate with the albumen of the surface of the ulcer; 
and probably also with chloride of sodium in the secretions. This con- 
stitutes a slough, which gradually becomes dark, and is ultimately 
thrown off', — a new action having often been induced in the sound parts 
beneath the slough, so that, on its separating, the ulcer is sometimes 
found to be healed. With the view of changing the condition of the 
diseased surface, and destroying the morbid state, it is not unfrequently 
applied to chancres. It is likewise found to be very beneficial in 
fissured or excoriated nipples ; and in certain chronic cutaneous affec- 
tions. 

Dissolved in distilled water, in the proportion of from gr. 40 to gr. 
60 of the nitrate to a fiuidounce of water, it is applied, by means of a 
camel's hair pencil, in the same cases. 

35. CUPRI SULPHAS.— SULPHATE OF COPPER. 

Sulphate of copper— elsewhere described (Vol. i. p. 122)— commonly 
known under the name blue stone — is frequently used as an erodent to 
destroy fungous growths in ulcers. It is applied either by touching the 
surface of the proud jlesk with the solid sulphate; or the powder is 
sprinkled upon them ; or they are washed with a strong solution of it. 
It appears to enter into combination with some of the constituents of 
the tissues with which it is placed in contact. It would seem, however, 
jHto occasion but little decomposition of the part; and can scarcely— Dr. 
Christison thinks — be regarded as a corrosive. It is, doubtless, a pow- 
erful excitant, and induces a new action in ulcerated parts so as to 
give occasion, in many cases, to their cicatrization. When applied in 
solution, the proportion may be gr. ij to gr. viij of the salt to a fluid- 
ounce of water. 

The powder is sometimes rubbed on warts, simple or syphilitic; and 
a strong solution may be used for the same purpose. 

36. CUPRI SUBACE'TAS.— SUBAC'ETATE OF COPPER. 

Subacetate of copper, JErugo, Verdigris, whose general properties 
> have been described elsewhere, (Vol. ii. p. 71,) is not unfrequently 
employed as an erodent in cases of warts and fungous growths, and as 
a detergent to foul ulcers. It may be sprinkled, in powder, over the 
surface of the ulcer ; and when mixed with savine powder is occa- 
sionally rubbed over venereal and other warts. It is occasionally used 



ERODENTS. — SACCHARUM. 



267 



in certain chronic cutaneous affections; and has proved highly service- 
able in ringworm of the scalp. 

UNGUENTUM CUPRI SUBACETA'TIS, OINTMENT OF SUBAC'ETATE OF COPPER. 

(Cupri subacetat. in pulv. subtiliss. 3J ; Unguent, simpl. 3xv.) This 
may be employed in the cases above described. When reduced with 
lard, it is applied in ophthalmia tarsi,— at bedtime especially, — with the 
aid of a camel's hair pencil. 

37. ALU'MEN EXSICCA'TUM — DRIED ALUM. 

Dried alum is alum melted in an earthen or iron vessel over the fire, 
the heat being continued until it becomes dry. The alum is then 
rubbed into powder. 

It is chiefly used, as an erodent, to destroy exuberant granulations on 
ulcers ; for which purpose, it may be sprinkled over the surface. It 
acts, also, as an excitant to indolent ulcers. 

38. AC'IDA MINERA'LIA.— MIN'ERAL ACIDS. 

Sulphuric, Nitric and Muriatic acids, pure, or diluted with water, 
are used as erodents, chiefly in cases of warts and corns ; and the same 
may be said of 

39. AC'IDUM ACE'TICUM.— ACE'TIC ACID. 

This is formed, according to the process introduced into the last edi- 
tion of the Pharmacopoeia of the United States, by decomposing acetate 
of soda by means of sulphuric acid, and distilling until the residuum 
becomes dry. The resulting acetic acid is mixed with red oxide of 
lead, and again distilled to dryness to remove the sulphurous acid, which 
has passed over in the first distillation. This acid has a specific gravity 
of 1.06 ; and 100 grains of it saturate 83.5 grains of crystallized bicar- 
bonate of potassa. Acetic acid or radical vinegar, thus obtained, is a 
colourless volatile liquid ; having a pungent smell, and a strongly acid 
and corrosive taste. 

40. SABI'NA.— SAVINE. 

It has been just remarked, that savine powder is added to powdered 
subacetate of copper, to form an efficacious agent for the removal of 
syphilitic warts; and that the cerate is used as an irritant to maintain 
a discharge from ulcerated surfaces. A strong infusion is likewise em- 
ployed in cases of warts and indolent ulcers ; and, in certain chronic cuta- 
neous diseases — as scabies, and porrigo favosa. The expressed juice 
of the plant, diluted with water, has been applied in the same cases. 

41. SACCHARUM.— SUGAR. 

Refined sugar (Vol. i. p. 246,) in powder, is sometimes sprinkled 



268 



SPECIAL REVELLENTS. 



over the surface of ulcers of which the granulations are exuberant • is 
blown into the eye, in specks of the cornea ; and into the throat in 
diphthentis. It is probable, however, that it acts in these cases merely 
as an excitant ; modifying the condition of nutrition of the parts beneath 
and thus removing the morbid state. It is in this way, doubtless thai 
specks of the cornea are taken away,— not by any corrosive action o 
the sugar. J J luu UI 



2. Actual Cauterants. 
42. CALOR'IC. 



The application of free caloric in a certain degree of intensity to the 
surface of the body is a valuable revulsive agency. As an actual cau 
terant, it is employed to produce disorganization of the part with which 
it is made to come in contact ; and thus either to excite a new action in 
he morbid structures beneath the slough formed ; or to constitute cen- 
tres of irritation, which may act as revellents in diseased actions going 
on elsewhere Actual cauterants are much more powerful disturbing 
agents, than the potential, which induce disorganization by slow com° 
bination with the elements of the tissues. The natural dread of fire 
however, prevents their use in this country to the extent that might be 
desirable ; and, therefore, the potential,— the apparently less formidable, 
and certainly less efficacious,— are made to take their place. 

rhere are two forms of actual cauterants which are used in practice- 
— hot iron and raoxa. ' 

1. HOT iron. 

A difference of action exists according to the degree t« which the 
temperature of the metal is carried. When the cautery is at a red heat, 
unless it be applied for a longer period, it does not so rapidly and com- 
pletely destroy the tissues as when heated to whiteness. The latter 

as 
that 
~ part takes place in- 
stantaneously ; and but very little feeling is experienced,-certainly far 
less than is caused by any form of the potential cautery, which destroys 
Dy slow degrees. In using the white hot iron, therefore, it is advisable 
to protect the surrounding parts by having pieces of thick paper wetted 
and applied layer upon layer, with a hole in the centre, of the size that 
is desired, so that the cautery can be brought in contact with a circum- 
scribed surface. This should be done quickly, inasmuch as the chief 
pain is occasioned by the approach of the heated metal to the skin. 

The application of hot iron is a powerful counter-irritant, and of great 
value in many internal diseases. It is rarely, however, employed in 
such cases; but is in use, especially in France, for destroying malignant 
growths. It was considered, in antiquity, as the last resource,-a dis- 
ease which hre could not cure being deemed incurable. 




ACTUAL CAUTERANTS. — MOXA. 269 



2. MOXA. 



The term raoxa is applied by the Chinese and Japanese to a cottony 
substance, prepared by beating the dried leaves of Jlrtemisia Chinensis, 
or, according to Lindley, of A. Moxa. With the down they form a 
cone, which is placed upon the part to be cauterised ; and set fire to at 
the top. This mode of cauterisation has been long practised by those 
people, and by the ruder nations of the old world; but it was not much 
employed in Great Britain and France, until about the commencement 
of the seventeenth century, when Ten Rhyne — a Dutch practitioner — 
introduced it from India. It fell, however, into disuse, until it was 
revived during the last century ; since which time it has been much 
used, especially by some of the French army surgeons. In other works, 
the author has referred to the various combustible substances employed 
by different nations in "moxibustion." 

In modern times, various substances have been used for the fabrica- 
tion of moxas. In Germany, they employ the tinder — amadou — which 
is agaric prepared for the purpose ; and it is not uncommonly employed 
in our hospitals, — a small disc or cylinder being placed on the part, 
and set fire to. It is now generally adopted in the French hospitals. 
The match, used by artillerists, was recommended by Baron Percy, 
after Bontius. It is composed of hemp, steeped in a solution of nitrate 
of potassa. He likewise proposed the pith of helianthus annuus, re- 
commending that the stalk should be cut into cylinders of the desired 
length, the bark being left on, so that, when ignited, and held in the 
hand, they may burn in the centre. Percy's moxas, prepared by M. 
Robinet, are said to be found in the London shops. They consist of 
pith, rolled in cotton, and enveloped in muslin. (Pereira.) That used 
by Baron Larrey, and very generally employed by many practitioners, 
is made by taking a quantity of cotton wool, pressing it somewhat 
closely together, and rolling it over a piece of fine linen which is fast- 
ened at the side by a few stitches. He advises, that it should have the 
shape of a truncated cone — the form usually adopted — and be about an 
inch long. It is generally, however, made shorter, and smaller than 
this. The moxa may be held in its place by means of two long hair- 
pins or wires, which are slightly bent so as to accommodate them to 
the shape of the moxa, by which it is retained in its proper position. 
For the same purpose, Baron Larrey employed a porte-moxa, consisting 
of a ring to receive the moxa, with a handle attached to it, and three 
small knobs or supports of ebony, placed beneath the ring to prevent 
the heated metal from acting on the skin. 

Professor Grafe, of Berlin, employed wafers, dipped in a mixture of 
three parts of oil of turpentine and one part of sulphuric ether. Before 
applying this inflammable matter to the skin, it is necessary to remove 
carefully from the wafer the superfluous liquid. These moxas are said 
to ignite readily, burn promptly and uniformly, and do not crepitate. 
Phosphorus has been recommended in the place of moxa, as more con- 
venient and safe. 

Of late, the following moxa has been recommended. Macerate 



270 SPECIAL REVELLENTS. 

strips of coarse cotton or muslin in a saturated solution of bichromate 
of potassa, and when nearly dry, roll them tightly on a piece of wire of 
the twentieth of an inch in thickness, until the cylinder shall be about 
three-fourths of an inch in diameter, or as thick as may be thought de- 
sirable. The roll must then be wrapped round very tightly with strong 
thread, and covered with a piece of fine muslin stitched over it. The 
wire may then be withdrawn, and the cylinder completely dried. 
When wanted for use, a small piece of the requisite length may be cut 
off' by a sharp knife and be fixed on the part by a piece of adhesive 
plaster having a cross cut in the centre. This moxa burns with a more 
uniform and steady ignition than those prepared with nitre. 

To prevent the surrounding parts from being burnt, a wet rag may 
be placed on the skin, having a hole in it large enough to receive the 

moxa. 

In the application of most of the moxas, their effects can be so gra- 
duated as to produce simple rubefaction, or vesication, or the forma- 
tion of an eschar. Where a rubefacient action is alone desired, the 
cylinder may be removed, when the pain becomes somewhat severe; 
or the material in ignition may be held close to the surface, and be 
moved gradually along it. In this way, a counter-irritant effect may be 
exerted along the spine or any extensive surface. Any burning sub- 
stance—a lighted coal, for example— will answer for this purpose. 
When it is desired to induce vesication, the moxa must be kept on 
longer ; and if it be required to produce an eschar, it may have to re- 
main on until it is wholly consumed. Baron Larrey, indeed, advises 
that the blowpipe should be occasionally employed to hasten its com- 
bustion. When the integument has once become disorganized, the 
slough will be thrown off in due time, leaving an ulcer. Baron Larrey 
says°that the sloughing can be prevented by the application of liquid 
ammonia to the burnt surface, after the moxa has been removed. This 
will do, when the disorganization is partial ; but the author knows from 
experience, that when such is not the case it will often fail. 

3. Potential Cauterants. 
43. POTAS'SA.' 

Potassa, Caustic potassa, Hydrate of potassa, Pure kali, Lapis infer- 
nalis, strongest common caustic, is prepared by evaporating liquor po- 
tassse till ebullition ceases, and the potassa melts. It is then run into 
moulds ; and, when cold, is kept in well-stopped bottles. As met with 
in the shops, it is either in fragments of plates, or in pencils of a gray 
or green colour. It is very deliquescent ; and greedily attracts carbonic 
acid from the air. It is very soluble in water, dissolving in less than 
its weight ; and, unlike carbonate and bicarbonate of potassa, is solu- 
ble also, in alcohol. It always contains various impurities, but they do 
not interfere with its medicinal action. 

Caustic potassa is a powerful destroyer of organized tissues, combi- 
ning rapidly with fibrin and albumen, and corroding and destroying the 
cuticle so as to give occasion to a saponaceous feeling, when rubbed 



POTENTIAL CAUTERANTS. — ZINCI CHLORIDUM. 271 

between the fingers. It is the most common caustic application for 
forming issues ; although its extreme deliquescence is an objection to 
it. To obviate this, layers of adhesive plaster should be placed on the 
skin, with a hole of the proper size cut in their centre; and on the ex- 
posed skin, the extremity of a piece of potassa must be rubbed until 
the skin is discoloured. The part may then be washed with water or 
with vinegar ; and a bread and milk or a flaxseed poultice be applied. 
In a few days, the eschar will be detached, after which the ulcer may 
be kept open by the issue pea and plaster; or by any of the suppurant Uy4~*. 
ointments already referred to. Like nitrate of silver, it has been applied 
to poisoned wounds ; and, inserted at the extremity of an appropriate 
bougie, to strictures of the urethra. Mr. Whately affirmed, that this 
application might be employed with entire impunity ; but the appre- 
hensions of practitioners, owing to its great deliquescence, have pre- 
vented them from adopting it extensively ; and it is now rarely used. 

A solution of potassa 5iss, in distilled water f.^ij, has been recom- 
mended by Dr. Hartshorne, of Philadelphia, to be drawn quickly along/-w 
the spine, by means of a sponge attached to the end of a stick, in teta- 
nus. It acts as a powerful rubefacient. 

Potassa cum Calce, Potassa with Lime, is in the London and 
Edinburgh Pharmacopoeias. It is formed by the union of equal parts of 
Potassa and Quicklime; which are rubbed together, and kept in a well- 
stopped vessel. This is the milder common caustic; yet although so 
called, it is a powerful potential cauterant. It is not wholly soluble in 
water, unless the water be in very large proportion; and is only partly 
soluble in alcohol. It is employed for the same purposes as potassa. 
It is usually made into a paste with alcohol, and applied to the part to 
be cauterized. It is slower in its operation, and less deliquescent than 
potassa, and therefore less liable to spread beyond the part to which it 
is applied. 

44. ZINCI CHLO'RIDUM".— CHLORIDE OF ZINC. 

Chloride or Butter of Zinc, whose general properties are described 
under Tonics (Vol ii. p. 66,) has been recommended as a caustic, that 
does not exert any disagreeable influence on the organism. It has been 
used by Hancke and others to form issues, which it does in from six to 
eight' hours; and has only been considered superior to many other 
caustics, where the destruction of a considerable thickness of structure 
is required, or where the removal of an excrescence in this manner is 
preferred by the patient to the knife. Nitrate of silver has been con- 
sidered superior in promoting a sound action, when the unhealthy sur- 
face or stratum of the ulcer is superficial. Chloride of zinc has' been 
used successfully for the destruction of naevi materni, and lupus, and 
in cancerous and malignant growths and ulcerations ; and has been 
largely employed in this country. It is, indeed, an excellent cauterant. 

Chloride of zinc may be applied as a caustic by means of a camel's 
hair pencil, either alone, or mixed with an equal portion of oxide of 



272 



SPECIAL REVELLENTS. 



zinc, sulphate of lime, or wheaten flour. To give it the proper con- 
sistence, from twenty-four to thirty drops of water may be added to 
each ounce of the chloride. It seems to act not only chemically, by 
destroying the part with which it comes in contact, but dynamically on 
the neighbouring living tissues,— as the appearance of the parts beneath 
is generally greatly improved after the separation of the eschar. 

In the strength of two grains to the fluidounce of distilled water it 
has been applied two or three times a day on lint to atonic ulcers; and 
when reduced by solution in water or wine, or mixed with oil or'lard 
has been used in paralysis as a rubefacient. 

45. ARGEN'TI NITRAS.— NITRATE OF SILVER. 

Of the uses of nitrate of silver as an erodent, mention has already 
been made. As a cautecant, it has been employed to cut short the pro- 
gress of variolous pustules, and to prevent pitting ; with which view 
it is used on the first or second day of the eruption ; the solid nitrate 
being applied to each pustule, after their tops have been removed. It 
has occasionally been used in the same manner in cases of herpes 
zoster. 

In strictures of the urethra and oesophagus, the nitrate is put into the 
extremity of a bougie, and passed down to the seat of the obstruction; 
and in the former affection, it has often entirely succeeded, — not appa- 
rently^)- destroying the stricture, but by inducing some change in the 
vital actions of the part, which is followed by relaxation of the nar- 
rowed portion of the canal, " but which change is as difficult to explain 
" as is the subduction of external inflammatory action by the application 
of this salt." (Pereira.) 

By rubbing the solid nitrate, moistened, over a portion of the cuta- 
neous surface for some time, the vitality of the integument may become 
so much impaired, that an eschar may be caused, which, when it sloughs 
off, forms an issue ; but it is rarely used for this purpose. It is an ex- 
cellent application, however, in phagedenic ulcerations of all kinds, 
gangrenous stomatitis, &c, in which it is necessary to destroy the sur- 
face, and induce a new action in the parts beneath. 

[46. ANTIMO'NII MU'RIAS.— MU'RIATE OF ANTIMONY. 

Muriate or Sesquichloride, Hydrochlorate or Chlorohydrate of Mi- 
mony, Oil or Butter of antimony, as met with in the shops, is usually 
prepared by dissolving roasted sesquisulphuret of antimony in chlorohy- 
dric acid. It may also be made by dissolving crude antimony in the 
same acid. It is a transparent liquid, the colour of which— dependent 
on the iron it contains— varies from yellow to deep red. When applied 
to a wounded surface, it acts as a powerful caustic, forming an eschar 
without any excessive pain ; hence, it is sometimes used in cases of 
poisoned wounds, and as a caustic to sloughing ulcers. It is not much 
employed, however, and is not admitted into the Pharmacopoeias of 
Great Britain, or into that of this country. 



POTENTIAL CAUTERANTS. — ACIDA MINERALIA. 273 

47. ACIDA MINERA'LIA.— MIN'ERAL ACIDS. 

The mineral acids are sometimes employed as caustics, especially 

Ac"idum Ni'tricum, Nitric Acid. This is not used, however, to 
form issues ; but is applied not only to destroy warts, but to disorganize 
the surface of foul phagedenic ulcers ; and as a caustic to the bites of 
rabid animals or venomous serpents. With this view, it is applied un- 
diluted, and is kept in situ, by smearing the surrounding parts with some 
resinous ointment. An eschar is in this manner formed, which falls off; 
and the base of the ulcer is often found to have assumed a new action. 
It may be applied by means of a piece of sponge or linen rag tied 
around a small piece of stick. Sometimes it may be necessary to cut 
through the slough, so as to make the acid reach the living tissues be- 
neath. In the strength of about f.5j of acid to Oj of water, it is a good 
application to foul ulcers ; and when still farther diluted — "Ixij to water (V ^ ( ^. 
Oj it is an excellent stimulant to atonic ulcers. Dr. Houston, of Dublin, 
has recommended the strong acid as an application to the " internal 
bleeding pile," " that soft, red, strawberry-like elevation of the mucous 
membrane," for which he uses the term, "vascular tumour." The acid 
of specific gravity 1.500, he has found of eminent service, — combining 
— he affirms — all the advantages possessed by excision and ligature, with- 
out any of their disadvantages. He directs the application to be made 
in the following manner. Let the patient strain as on the night-chair, 
so as to bring the tumours fully into view ; and whilst they are so down, 
let him either lean over the back of a chair, or lie down in the bent 
posture on the side on which the disease exists, with the nates over the t\x^*&J 
edge of the bed. Let a piece of wood, cut into the shape of a 
dressing-case spatula, be dipped in the acid, and then, with as much 
of the acid adhering to it as it will carry without dripping, let it be 
rubbed on the tumour to the desired extent. The due effect of the acid 
on the part is shown by its becoming of a grayish white colour. If a 
superficial slough be all that is required, a single application may be 
enough ; if a more deep one, two or three applications ; and if a still 
more deep one, two or three applications of the wood dipped in the acid 
may be made in quick succession, and these being finished, the part must 
be well smeared over with olive oil. The prolapsed parts must then be 
pushed back within the sphincter, the patient be put to bed, and an 
opiate administered. The pain is sharp and burning at first, but goes 
off in two or three hours. In no case has Dr. Houston heard of serious 
consequences from the remedy, and the symptoms usually following its 
application are so mild as not to absolutely require confinement to bed 
more than a few hours. 

The safety and efficacy of this practice have been testified to by Mr. 
Cusack, of Dublin. 

Unguentum Acidi Nitrici of the Dublin Pharmacopoeia, (01. Oliv. 
$j ; Jidipis ^iv ; Acid. Nitric f-3vss;) is used in various skin diseases^^^^. 
— for example, in scabies, poirigo, &c, and occasionally as a dressing 

Vol. II.— 18 



274 



SPECIAL REVELLENTS. 



to syphilitic and other obstinate ulcers, in which it is advisable to induce 
a new action. 

Sulphuric and Muriatic Acids are employed in the same manner • 
and for similar purposes. 

48. AC'IDUM CHRO'MICUM.— CHROMIC ACID. 

Chromic acid, peroxide of chromium, is formed by adding a cold 
saturated solution of "Bichromate of potassa to concentrated oil of vitriol 
On cooling, the chromic acid crystallizes in brilliant crimson prisms It 
is very deliquescent, and dissolves in water and alcohol. 

It yields its oxygen readily to organic substances, becoming reduced 
to the state of green sesquioxide. Its action on the living surface is that 
of a chemical irritant, and it has been recommended by Mr. A. Ure as 
an escharotic. It is, he says, always convenient of application, as it 
consists of a thick crystalline pap, which, when rightly managed, does 
not spread beyond the prescribed limits, and its erodent operation termi- 
nates with its passing into the state of inert pulverulent sesquioxide. In 
a case of external hemorrhoids, the acid was applied twice at an inter- 
val of two days. It caused acute burning pain at both times ; destruc- 
tion, to a considerable extent, of the diseased texture; consolidation of 
the remainder, and permanent relief. 

49. AC'IDUM ARSENIO'SUM.— ARSE'NIOUS ACID. 

Arsenious acid— whose properties have been described elsewhere, 
(Vol. li. p. 86,) is a powerful caustic; and was at one time much used 
by surgeons in cases of cancerous and other morbid conditions in which 
it was advisable to destroy the parts. It was the basis, too, of several 
applications to cancers of a secret character— as the powder of Frere 
Cosme ; and one of a Dr. Hugh Martin, of this country—the Pate de 
Rousselot, Plunkett's paste, Febure's wash, &c, &c. When appropri- 
ately applied, it causes the death of the part; and, on the separation of 
the slough, a healthier action of the parts beneath is sometimes induced. 
Its precise chemical influence on the tissues does not appear to be known. 
It would seem, however, important, that the caustic should be so strong 
as to completely disorganize ; otherwise the poison is apt to be absorbed. 
Cases, indeed, are recorded, in which it has proved fatal in this manner; 
and it has not even been applied in all cases with impunity, when the 
skin was whole. On these accounts the arsenical caustic is but rarely 
prescribed in cancer, lupus, onychia maligna, and the other affections in 
which it was at one time much used by surgeons. Absorption is thought 
to have occurred most frequently from bleeding surfaces. 

The former Pharmacopoeias of the United States had Ceratum 
Arsenici, composed of Arsenious acid, in very fine powder, a scruple; 
simple cerate, an ounce ; which was sometimes used as a dressing to 
cancerous ulcers. It has been dismissed in the last edition. 



POTENTIAL CAUTERANTS. ACIDUM ARSENIOSUM. 275 

According to Mr. Carmichael, Arseniate of Iron acts more power- 
fully on the vitality of cancerous formations than any other agent. Of 
late, he has employed a compound of this salt and phosphate of iron, — 
half a drachm of the former to two drachms of the latter, and six ^^ 
drachms of lard. This is applied by means of a camel's hair pencil; 
but not over the whole surface of the ulcer when extensive ; or it may 
be applied spread on lint. 

Iodide of Arsenic has been used with advantage in the form of oint- 
ment, (Arsenic, iodid. gr. iij ; Adipis 3j ;) in case».of phagedenic tuber-^ 
culous lupus. 

50. Hydrar'gyri Chlo'ridum Corrosi'vum; 51. Hydrar'gyri 
Iod'idum Rubrum ; and 52, Hydrar'gyri Ox'idum Ruerum, are oc- 
casionally used as caustics to malignant growths and ulcers ; but their 
application in this manner will be referred to under another head. (See 
Eutrophics.) 

53. Hydrar'gyri Nitras Ac"idus. — Acid Nitrate of Mercury. — 
Liquor Hydrargyri super "nitratis, Solution of supernitrate of mercury. 
Liquid acid Deutonitrate of Mercury, has been introduced as a power- 
ful caustic, and has been much employed to destroy malignant ulcer- 
ations, especially when of a cancerous character. It is prepared as 
follows. — Take of pure mercury, 100 parts ; commercial nitric acid (den- 
sity about 1.380), 200 parts. Dissolve the mercury in the acid with 
the aid of heat, and evaporate until it is reduced to 225 parts. 

It is applied by means of a camel's hair pencil; and if necessary the 
parts may be washed afterwards with water ; or, where practicable, they 
may be covered with lint. 

54. Liquor Ammo'nije (Vol. i. p. 500,) is applied occasionally in 
cases of the bites of rabid animals, so as to destroy the surface with 
which it comes in contact. 

55. Creasote (Vol. i. p. 498,) has proved beneficial as a caustic — 
applied pure, or diluted with water — in atonic, foul and offensive ulcers ; 
in scrofulous caries ; sloughing carbuncle; cancerous ulcerations ; lupus, 
and condylomata. When undiluted, it may be applied by means of a 
camel's hair pencil. 

56. Nitro-Muriate of Gold has been applied to cancerous tumours 
and ulcers. It is prepared by dissolving six grains of chloride of gold 
in an ounce of aqua regia ; and is applied like other corrosive agents, — 
care being taken that it is confined to the parts to be acted upon. 



276 EUTROPHICS. 



VII. EUTROPH'ICS. 

Eutrophics defined— Alteratives — Modify the function of nutrition— Sorbefacients— .Thera- 
peutical application of eutrophics — Pressure— Friction — Special eutrophics. 

It has been at all times admitted, that there are agents, which, when 
taken into the system in small doses, act on morbid structures and con- 
ditions, so as to occasion their removal, without any sensible evacuation 
or operation. To such remedies, the term alteratives,— [Mterantia 
JJlloiotica,]— has generally been applied ; but in admitting such a class 
of therapeutical agents, caution is necessary, lest we should assign to 
the insensible influence of the remedy what ought to be ascribed to the 
recuperative power, which the system, and every part of it, possesses, 
and to which the author has had occasion to allude more than once in 
the course of these volumes. Perhaps there is no class of remedies 
that is more interesting and more difficult to be understood. 

The term alterative has, however, been used indefinitely; and in 
reality every agent that we have thus far considered, must be esteemed 
an alterative, seeing that it must modify or alter, directly or indirectly, 
one or more of the functions. Tonics induce their effects by the im- 
pression they make on the nervous system ; yet that impression is 
exerted slowly, and is not accompanied by any sensible evacuation: 
hence they seem to belong properly to the class of alteratives. In a 
modern work, indeed, the definition of these two classes of agents has 
been given in a manner somewhat different from the common accepta- 
tion. " There are agents," says MM. Trousseau and Pidoux, "which 
afford to the organic elements something that survives the primary im- 
pression of the medicine; at time s this is a constituent element, or a 
more perfect functional aptitude: these take the name of Tonics. At 
others, on the contrary, they change the character of the blood, render 
it less adapted for interstitial nutrition, and for furnishing elements for 
acute or chronic phlegmasia : these take the name ot alteratives." As 
the author is desirous of classifying under one head the different internal 
remedies which are capable of modifying the fluid of the circulation, so 
that when it permeates the intermediate system of vessels it may impress 
them differently, and thus alter morbid actions that may be taking place 
in them, he has adopted the term Eutrophics for this class of thera- 
peutical agents. 

Eutrophics— from iV , "well," and rpo^ "nourishment"— may then be 
defined — agents whose action is exerted on the system of nutrition, 
without necessarily occasioning manifest increase in any of the secre- 
tions. 

There are but two ways, perhaps, in which alteratives can exert their 
agency on the system ; one is by the new impression they make directly 
on the nerves ; the other, by the way of absorption. Tonics, it is pro- 
bable, act in the former manner; eutrophics, which occasion absorption 
of the solid parts of the body, — most substances, indeed, which impress 
new activity on the capillary action,— generally in the latter. 

If corrosive sublimate or arsenic be given in small and oft repeated 



EUTROPHICS. 277 

doses, in obstinate cutaneous affections, we may discover that the erup- 
tion fades gradually away ; and that, after a time, the parts are restored 
to health. The same thing happens, if we administer saccharine solu- 
tions in the manner described hereafter. All this occurs without any 
manifest evacuation ; and is, therefore, referable to eutrophic agency. 
The mode in which this is probably exerted, is by the changes pro- 
duced in the circulating fluid by the substances in question. The 
altered fluid enters the intermediate circulation ; changes the character 
of the nutrition accomplished there, by the impression made on the 
capillary vessels ; and in this way a new action is assumed by them, 
which breaks in upon the old ; the affinities are modified ; and harmony 
succeeds to the irregularity of action previously existing. It is in this 
way, that we explain the efficacy of mineral waters, and many other 
agents, which have had the reputation of ' purifying the blood ;' and 
which doubtless impress changes on that fluid. We know, from direct 
experiment, that the presence of saline matter in the blood is essential 
to its due constitution, and conversion in the lungs ; and we can readily 
conceive, that saline substances, contained, in a dilute state, in mineral 
waters, may pass into the venous system by imbibition; and so modify 
the constitution of the fluid of the circulation, that when it attains the 
intermediate circulatory system — where all nutrition is effected — the 
modified pabulum may so impress the organs that preside over nutritive 
exhalation, that new vigour may be communicated to the function ; and 
old morbid cachexies, or dyscrasies — as they are more frequently termed 
by the German writers — disappear. " Though great allowance," says 
a modern observer, Mr. E. A. Jennings, " must be made for the effects 
of change of air, relaxation from business, change of habits, and other 
accidental circumstances, yet all candid observers must acknowledge, 
that when due allowance has been made for all these circumstances, a 
large residuum of cases remains where the most surprising good effects 
have been produced by a course of mineral waters. From the effects 
generally produced by them on the kidneys, it is evident, that a large 
portion of the water is absorbed, and it is probable that their good effect 
is to be attributed as much to the alteration they produce in the chemical 
character of the blood, by entering into its composition, as to the increase 
they occasion of the secretions of the bowels. My own observations 
and analyses would favour this opinion ; but they are, at present, too 
few to enable me to express any decided opinion on the subject." 

At one time, it was a common belief, that the condition of the blooa 
may be extensively modified by the infusion of various substances into 
it ; but the plan is rarely adopted at the present day. It was even ad- 
vised formerly, that blood should be taken from another individual, and 
transfused into the blood-vessels, to 'alter' the objectionable qualities 
of the circulating fluid; but, at this time, transfusion of blood is only 
employed when the blood-vessels have been drained, — by uterine he- 
morrhage, for example. Fresh excitation has thus been communicated 
to the organs ; and the patient has appeared to rally, in some instances, 
where hope had been almost abandoned. 

It is obviously only in diseases of a chronic character, that eutrophics 
can be employed. One of the essential elements of their operation is 



278 EUTROPHICS. 

time. None of them can act immediately, if we except the alterative 
effect of change of air, society, and scenery, the influence of which on 
morbid conditions— kept up by habit, as it were— is often as rapid as it 
is striking ;— but these are tonic agencies. The reflecting practitioner 
will readily see, that in adopting any plan of alterative management, he 
must be guided by the great principles, which have been canvassed in 
the preceding chapters and sections ; and especially in the one devoted 
to the consideration of Revellents. Some of the revellents, employed 
in protracted disease, are altogether eutrophic. Of this nature are the 
preparations of mercury and iodine, administered to break in upon the 
morbid catenation in febrile, inflammatory, syphilitic, and other disor- 
ders, that have run on for a length of time ; hence the eutrophic treat- 
ment of syphilis by mercury has been by modern syphilographers termed 
the revellents in contra-distinction to the simple. 

A class of sorbefacients has been admitted by a few writers on thera- 
peutics. At one time, it appeared to the author to be necessary in 
order to explain the operation of a multitude of medicinal agents; and 
was accordingly adopted in the first edition of his ' General Therapeu- 
tics;' but farther reflection has induced him to class those agents under 
the head of Eutrophics. They are defined— agents that promote ab- 
sorption : for, however it may be effected, the result of their successful 
operation is to give occasion to the taking up of that which has been 
deposited ; yet this is unquestionably accomplished by the modification 
Which they impress on the function of nutrition. 

To understand the mode in which their agency is exerted, it may be 
well to inquire briefly into some of the phenomena of absorption and 
nutrition. In another work, {Human Physiology, Vol. i.,) the author 
has entered, at length, into the consideration of absorption, of which 
there are three great varieties,— -first, that which is exerted by the skin 
and mucous membranes, and which, of course, includes chylosis;— 
secondly, that which is effected upon secreted fluids, which are termed 
'recrementitial,' or, in other words, pass again into the mass of blood; 
--and thirdly, that which is concerned in the taking up of solid parts 
in the function of nutrition. 

Every argument induces the belief, that from the commencement of 
existence until its final cessation, perpetual changes are taking place- 
both of absorption and deposition — which affect the decomposition and 
renovation of each organ, as well as of the different recrementitial 
fluids of the economy. The precise character of the apparatus, by 
which nutrition — as this important function has been termed — is accom- 
plished, we have no means of knowing. Almost all admit, that the old 
matter must be directly or indirectly taken up by absorbents, and the 
new be deposited by arteries; but, as the precise arrangement of these 
minute arteries and absorbents is imperceptible to the eye, even when 
aided by optical instruments, their disposition has given occasion to 
much controversy. The generality of anatomists and physiologists con- 
ceive deposition to be effected by the minute arterial ramifications ; but 
some presume, that inconceivably small vessels are given off from the 
capillary arteries, which constitute a distinct order, and whose function 
it is to exhale the nutritive deposit. Hence, these vessels have been 



MODUS OPERANDI. 279 

termed exhalants or nutritive exhalants ; although, when the term is 
used by writers, they do not always pledge themselves to the existence 
of any distinct set of vessels; but merely mean by it the capillary ves- 
sels, whatever may be their nature, which, with the cells, are the agents 
of nutrition, and form from the blood, bone, muscle, tendon, ligament, 
&c, as the case may be. 

A like discordance has existed regarding the precise agents of de- 
composition. All admit, as has been seen, that the absorbents receive 
the product of absorption ; but all have not conceived that the action 
of taking up solid parts is accomplished immediately by absorbents. 
It was formerly believed, that there is a kind of spongy tissue, termed 
a * parenchyma,' and that this sponge is situate at the extremities of the 
lymphatic vessels ; that it is a vital sponge or vital parenchyma, — absorb- 
ing, in other words, by virtue of vital properties residing in it ; but it 
was maintained that the solid parts of the body are broken down by 
the same agents — the extreme arteries — that secreted them ; and being 
reduced to the proper fluid condition are imbibed by the vital sponge, 
and transmitted into the lymphatics. The author has elsewhere shown, 
that all this arrangement is supposititious ; and that we know not posi- 
tively how the exhalants and absorbents are disposed in the capillary 
system. Independently of anatomical considerations, it does not seem 
probable, that the same vessels are endowed with antagonizing powers, 
of pulling downj and building up ; although it is probable, that the 
texture of a part to be absorbed is modified by the secretion of fluid, 
as we know to be the case, when adventitious coagula are removed 
from the brain. The areolar tissue, condensed by the pressure, forms 
a serous membrane surrounding the coagulum ; and this membrane 
secretes a fluid, which reduces the clot to the liquid state, so that it can 
be absorbed. 

An attentive examination of the functions of absorption and nutrition 
seems to lead to the conclusion, — that the chyliferous and lymphatic 
vessels form only chyle and lymph ; that the veins admit every liquid, 
which possesses the necessary tenuity ; and that, whilst all absorptions 
— which require the substance acted upon to be decomposed and trans- 
formed — are efifected, through the agency of cells, by the chyliferous 
and lymphatic vessels, those that require no alteration are accomplished 
directly through the coats of the veins by imbibition. 

The agents to which the absorption of decomposition, or — what has 
been termed— ' interstitial' or ' organic' absorption, should be referred, 
can, therefore, be readily deduced. As it is exerted on solids ; and as 
these cannot pass through the coats of the vessels in their solid condi- 
tion, it follows, that other agents than the veins must accomplish the 
process; and, again, as we never find in the lymphatic vessels any 
thing but lymph ; and as we have every reason to believe, that an action 
of selection is exerted at their extremities, similar to that of the chyli- 
ferous vessels on the heterogeneous substances exposed to them ; we 
naturally look to the lymphatics as the sole organs, concerned in the 
absorption of solids. 

With regard to the absorption of recrementitial humors, less difficulty 
exists. Where they possess the necessary tenuity, they may pass into 



280 EUTROPHICS. 

the blood-vessels by imbibition, or they may be taken up by the lym- 
phatics, and conveyed into the circulation. 

It is obvious, that, in the case of all these fluids, a nice balance must 
exist between the quantity exhaled, and that which is taken up again by 
the absorbents ; and if, from any cause, the balance should be destroyed, 
so that the exhalants are in a state of super-excitation, — or the absorb- 
ents in a state of diminished action, whilst the exhalation is healthy, — 
accumulation of fluid arises; and hence, the dropsical effusion into 
serous or cellular cavities — constituting hydrothorax, hydrops pericardii, 
ascites, &c— may be either of an active or more passive kind ; and the 
treatment may have to be modified accordingly. But these— as the 
author has before observed — are not the only causes that give rise to 
such accumulations. A viscus of the thorax or abdomen may, from 
protracted irritation, become engorged, indurated, or obstructed ; and 
from this mechanical cause, the circulation through it may be impeded ; 
accumulation of blood in the vessels — in other words, turgescence or 
congestion — supervenes ; and the watery portions transude. These are 
the worst kind of dropsies, because they arise from organic mischief, 
which does not itself admit perhaps of cure. 

The activity of absorption is much modified by the state of repletion, 
or the contrary, of the vessels ; as well as by the condition of the ves- 
sels themselves, as regards the presence or absence of excitement. If 
fluid be thrown into the vessels of a living animal so as to induce arti- 
ficial plethora, and any absorbable fluid be placed in the cavity of the 
peritoneum, absorption is apparently null, — or, at least, imperceptible; 
but if blood-letting be practised, so as to diminish considerably the 
amount of the circulating fluid, the liquid, thrown into the cavity of the 
peritoneum, is seen to disappear gradually as the blood is withdrawn. 
Hence, we infer, that blood-letting must be an important remedial agent 
in many cases of dropsy; and the same remark applies, although to a 
less extent, to every kind of depleting agent. 

That the energy of absorption is materially modified by the condition 
of the absorbing surface is well exemplified, as a modern writer — Pro- 
fessor Jackson, of Philadelphia — has observed, in the congestions, and 
consequent remora of the circulation, so frequently existing in the gas- 
troenteric mucous membrane in the advanced period of fevers, in which 
" medicinal substances, and remedies addressed to that surface, fail to 
produce their effects. Patients in this state cannot be salivated ; the 
mercurial medicine remains on the surface to which it is applied; stim- 
ulants, diuretics, diaphoretics, disappoint of their expected operation. 
Even fluids cease often to be absorbed, and accumulate in the stomach 
and intestines, where they are found with the remedies administered 
before death." The same fact is exhibited in malignant cholera, in 
which it is impossible to produce absorption — in the advanced stages 
of the disease at least — by any agency ; and hence, it has been proposed 
to throw fluids immediately into the mass of blood by injection : a 
course, which has not, however, fulfilled al] the ends, that were at one 
time, somewhat extravagantly, expected from it. 

Cases of hypertrophy of different organs afford an example of that 
loss of compensation between exhalants and absorbents, which has been 



MODUS OPERANDI. ' 281 

described as a cause of dropsy. The writer, to whom reference has 
just been made, considers it " extremely equivocal," whether dropsy be 
ever the result of a suspension of absorption alone, or simply from a loss 
in the equipoise of secretion or exhalation, and absorption. No facts, he 
thinks, justify the conclusion. But the circumstance, that certain agents 
so modify nutrition as to occasion the taking up of hypertrophied parts, 
appears to be a sufficient reply to this. The exhalants are already too 
much excited, and yet a peculiar ' stimulant' gives occasion to the pre- 
dominance of absorption, — of course by acting on a different set of ves- 
sels than the exhalants; for, if the excitant property were exerted upon 
them, the hypertrophy ought to augment, rather than diminish, — a cir- 
cumstance, which seems to refute the idea, that the exhalants fulfil the 
double function of depositing and breaking down, in nutrition ; and 
confirms the almost universally received opinion, that the exhalants are 
endowed with the former office — the absorbents with the latter ; the 
immediate agents, however, being the nucleated cells of which every 
tissue is composed. 

Connected with the subject of hypertrophy, M. Andral has the fol- 
lowing judicious remarks, which accord with the views that have 
always been entertained and taught by the author. " If from the simple 
observation of the phenomenon of hypertrophy, w T e pass to the study of 
its causes, what do we find ? Do we consider that we have explained 
the formation of this state by a greater afflux of blood than common 
towards the part which is to be hypertrophied? This congestion of 
blood may doubtless be conceived to play some part in the production 
of the hypertrophy. But, theoretically speaking, it neither appears to 
me to be the sole nor even the necessary condition. It is not the sole 
condition ; for the unusual appeal of blood towards an organ might 
take place in vain ; it would but engorge it without changing its tissue 
if there was not, in -the organ itself, an augmentation of the ordinary 
assimilative force : in this last condition, if I may use the expression, 
the assimilative force elaborates more actively the materials which the 
blood carries to it, and in order that it may draw them in superabund- 
ant quantity into its nutritive whirlpool, {tourbillon nutritif^) it is neces- 
sary to suppose that more blood arrives at it in a given time. . But is 
this excess of assimilative force itself necessary for the production of 
every hypertrophy, and may we not conceive cases, in which this force, 
remaining the same, there is a diminution of that other force, 'called 
disassimilating, (desassimilatrice,) by virtue of which the molecules of 
the solids are incessantly separated, to enter again into the mass of 
blood whence they had been drawn ? Is it not owing to this, that more 
than one case of hypertrophy, ineffectually treated by emollients, and 
blood-letting, have disappeared under the influence of stimulating sub- 
stances, (iodine, mercury, &c.) ? From these theoretical considera- 
tions, we arrive at the observation of facts, from which we may deduce 
the following conclusions. First. Hypertrophy is produced by the sim- 
ple fact of an augmentation of habitual activity in the exercise of the 
functions of organs. Secondly. Other hypertrophies occur in conse- 
quence of active hyperemia,— acute, but particularly chronic. In such 
case, we observe, that at times the hypertrophy exists only in the tissue, 



282 . EUTROPHICS. 

which has been irritated and in a state of hyperemia ; and, at others 
after the return of the latter to its healthy state, the neighbouring tissues' 
which were slowly modified in their nutrition, remain diseased, and 
hypertrophied. This may be proved in many cases of phlegmasia of 
the internal and external tegumentary membranes. Thirdly. There are 
cases of hypertrophy in the production of which we can only from 
analogy with the preceding cases admit the existence of a stimulus- 
physiological, or pathological— in the organ in which it is situate. We 
say, then, that there is nutritive irritation in such organ ; but why might 
we not say as well, that there is a diminution of activity in its regular 
action of decomposition ? In both these opinions I see only hypothe- 
ses. If such be the case, let not the therapeutics be supported exclu- 
sively on either of these opinions ; but, taking the hypertrophy for fact 
seek experimentally for the means of combating and destroying it! 
Thus, iodine has been found a remedy for hypertrophy of the thyroid 
gland ; and mercury has been found capable of destroying certain exos- 
toses, which are a true hypertrophy of the osseous tissue. Moreover, 
amongst those hypertrophies, whose cause has not been proved to be 
an antecedent or actual stimulation of the organ which is the seat of it, 
some consist of a purely local affection ; some appear to be intimately 
connected with the general nutritive movement; they -are only, so to 
say, one of the prominent expressions, that indicate or reveal the pro- 
found modifications, which the nutritive movement has undergone in 
every molecule of the body. Scrofulous individuals are in this cate- 
gory. Amongst the different groups of morbid phenomena presented 
by these individuals,— who has not remarked the simultaneous hyper- 
trophy, which the thyroid gland, the brain, several parts of the osseous 
system, the liver, the tongue and the upper lip undergo in them? He 
would appear to us but little of a physiologist, who, in each of these 
modifications of nutrition, saw only a local affection, and restricted his 
endeavours to the removal of it." 

Therapeutical application of Eutrophics. 

From what has been said, the jherapeutical application of eutrophics 
may be intelligible. Were we possessed of remedies, which act speci- 
fically on particular parts of the system of nutrition, all that would be 
requisite would be, — to select them according to the precise affection. 
As yet, however, we know of scarcely an agent that exhibits its special 
properties on any particular organ or tissue. Iodine is, perhaps, the 
only one. Its action appears to be exerted on the system of nutrition 
generally ; but more especially on that of the thyroid gland when en- 
larged. 

Where the object is to promote the absorption of any accumulation 
of recrementitial fluid— as in the case of dropsical collections— the sor- 
befacients we employ affect the system generally, and, through it, the 
pathological condition, which gives occasion to the accumulation. 
Hence, in active dropsies, blood-letting is doubly indicated. It reduces 
the erethism of the exhalants ; and, by diminishing the quantity of cir- 
culating fluid, adds materially to the absorbent energy; for, it has been 



MENTAL EUTROPHICS. 283 

seen, that in experiments on living animals, fluid is observed to be taken 
up from the serous cavities as blood is made to flow from a vessel. 
Somewhat in the same manner, cathartics, as well as diuretics, exert 
their beneficial agency. They detract from the fluid of the circulation ; 
but, in addition, like cathartics, occasion a concentration of vital ac- 
tivity towards the organ on which their specific stimulation is exerted ; 
and in this way, occasion the imbibition of the exhaled humour. 

The effect of mercury is to bring on a new action in the secretory 
system, on which it seems to act as a specific excitant. In this way, it 
becomes eulrophic, and is more frequently perhaps employed than any 
other, except iodine. Any local stimulant may be indirectly the cause 
of the disappearance of morbid parts, by modifying nutrition ; but there 
are few agents that act by stimulating specifically the absorbent system 
of the part ; they generally produce their effect, by occasioning a con- 
centration of vital activity towards some other part of the organism, 
and, under this operation, absorption is rendered more active. Expe- 
rience appears to show, that the administration of the alkalies is followed 
by sorbefacient effects, and Dr. G. Burrows, in his Gulstonian lectures 
for 1834, attributes their agency in promoting absorption to their affect- 
ing the parts to be absorbed — as they affect them out of the body — 
by rendering them more soluble; and, consequently, more readily ab- 
sorbed. 

There are agencies, that modify nutrition indirectly, but not by 
any change they induce in the fluid of the circulation, and which 
may, therefore, be called Indirect Eutrophics. The effect of tonics 
has been already referred to. The influence of the nervous system, as 
a modifier of nutritive action, is strongly exemplified, when powerful 
impressions are made upon it. 

Of this, we have examples in the effect of the imagination in discuss- 
ing tumours of various kinds. Some growths are possessed of but little 
vitality ; and if the nervous and vascular influence be detracted from 
them, they speedily die. This is the way in which charms remove 
warts. It is a popular superstition, that a dead man's hand rubbed on 
a wen, or an enlarged gland, will dispel it; and such is the occasional 
result ; as Perkinism, touching for the king's evil, &c, &c, are sorbefa- 
cient. It appears, consequently, that anything — of a physical or moral 
nature — that concentrates the vital activity on any part of the organism, 
may diminish the amount of exhalation in another part; and at the 
same time modify the function of absorption ; and, under this change in 
nutrition, parts may be reduced in bulk; morbid tumours disappear; 
and dropsical accumulations be absorbed. 

It is a general rule, applicable, perhaps, to every organ in the body, 
that its nutrition is augmented under appropriate exercise ; and that 
inaction is attended with more or less atrophy. This is manifested in 
the muscles of the arm of the prize fighter and fencer, which, in com- 
parison with those of mankind in general, appear to be hypertrophied. 
There are, however, certain secretions, which are more plenteously 
effected during inaction, and the absence of all stimulation, — the secre- 
tion of fat, for instance ; accordingly, if we are desirous of fattening 
animals, or of inducing artificial obesity, we keep them at rest, and in 



284 



EUTROPHICS. 



total obscurity; in order that they may not even experience the augmen- 
tation of the cutaneous and other secretions, which the slight stimulation 
of light occasions. In like manner, castration and spaying dispose to 
obesity, by removing the excitations, which the venereal passion engen- 
ders ; and, hence, the proverbial fatness of the eunuch, both in man and 
animals. These two cases of nutritive exhalation are constantly opposed 
to each other. Exercise developes the muscular fibre ; whilst want of 
it augments the exhalation of the fluid, which is deposited between the 
muscular fibres and fasciculi ; and which gives the rotundity so much 
admired in the delicate muscles of the female. In one case, we have 
hypertrophy of the organ exercised ; in the other, hypertrophy of the 
adipous exhalation. 

The influence of exercise and inaction on the production of fat has 
been accounted for ingeniously by Liebig. "A cow or a sheep in the 
meadow," he observes, " eats almost without interruption, as long as 
the sun is above the horizon. Their system possesses the power of 
converting into organized tissues all the food they devour beyond the 
quantity required for merely supplying the waste of their bodies. All 
the excess of blood produced is converted into cellular and muscular 
tissue ; the graminivorous animal becomes fleshy and plump, while the 
flesh of the carnivorous animal is always tough and sinewy. If we 
consider the case of a stag, a roe deer, or a hare, animals which con- 
sume the same food as cattle and sheep, it is evident, that when well 
supplied with food, their growth in size, their fattening, must depend 
on the quantity of vegetable albumen, fibrin or casein, which they con- 
sume. With free and unimpeded motion and exercise, enough of 
oxygen is absorbed to consume the carbon of the gum, sugar and 
starch, and of all similar constituents of their food. But all this is very 
differently arranged in our domestic animals, when, with an abundant 
supply of food, we check the process of cooling and exhalation, as we 
do when we feed them in stables, where free motion is impossible. 
The stall-fed animal eats, and reposes merely for digestion. It devours 
in the shape of nitrogenized compounds far more food than is required 
for reproduction, or the supply of waste alone ; and at the same time it 
eats far more of substances devoid of nitrogen than is necessary merely 
to support^ respiration and to keep up animal heat. Want of exercise 
and diminished cooling are equivalent to a deficient supply of oxygen; 
for when these circumstances occur, the animal absorbs much less 
oxygen than is required to convert into carbonic acid the carbon of the 
substances destined for respiration. Only a small part of the excess of 
carbon thus occasioned is expelled from the body in the horse and ox, 
in the form of hippuric acid; and all the remainder is employed in the 
production of a substance, which, in the normal state, only occurs in 
small quantity as a constituent of the nerves and brain. This substance 
is/a/f."— "The flesh of wild animals is devoid of fat; while that of 
stall-fed animals is covered with that substance. When the fattened 
animal is allowed to move more freely in the air, or compelled to draw 
heavy burdens, the fat again disappears. It is evident, therefore, that 
the formation of fat in the animal body is the result of a want of due 



FRICTION. 



285 



proportion between the food taken into the stomach and the oxygen 
absorbed by the lungs and the skin." 

It follows from these remarks, that if we wish to render the nutrition 
of an organ more active, we must take measures for keeping it in ap- 
propriate action ; and that, on the other hand, if we desire to diminish 
the nutritive exhalation, whose office is subsidiary to the organs, we 
must inculcate the due employment of corporeal exercise, with the view 
of augmenting the depuration accomplished by the cutaneous and pul- 
monary transpirations. 

Pressure is a sorbefacient influence, employed by the surgeon espe- 
cially. If a fractured arm be kept firmly bound by splints and bandages, 
for the ordinary period of a few weeks ; the arm is found much 
attenuated when the splints are removed, in consequence of the modi- 
fication of nutrition induced by the pressure. A knowledge of this and 
similar facts has led the surgeon to employ pressure in cases of ulcers, 
tumours, and morbid growths, where the application is at all feasible ; 
and, in this way, extensive ulcers have been made to heal ; and large 
tumours to disappear. A Mr. Young, of London, acquired much cele- 
brity by this mode of treatment in scirrhus and cancer; and, although, 
in such cases, it must unfortunately too often fail, good effects were cer- 
tainly produced by it in his hands, as they have occasionally been in 
those of others. It is, however, in the less malign kinds of morbid 
growths, that the remedy is most effectual, — more so, indeed, than per- 
haps any other plan of treatment. But it is not alone in cases of 
hypertrophies of the kind referred to, that pressure has been employed. 
Methodically used, it has been found useful in dropsical infiltrations into 
the areolar membrane of the lower extremities, as well as in ascites, and 
dropsical affections of other splanchnic cavities. In enlargements and 
dropsy of the ovaries, and other tumours within the abdomen, methodical 
compression has likewise been of essential benefit. In some cases of 
ovarian enlargement, the author has found an appropriate "bandage around 
the abdomen of great service. Not only has it supported the parietes of 
the abdomen and the contained parts, in sudden shocks ; but it appears 
to have even lessened the hypertrophy. 

Of late years, compression has been recommended in inflammatory 
affections, as in acute rheumatism ; in phlegmonous and erysipelatous 
inflammation of the extremities; in severe burns; in inflammation of 
the synovial apparatus ; orchitis ; &c. ; and in many cases it has been 
productive of great advantage ; — acting probably in two ways, — first, 
by diminishing the circulation in the intermediate system of vessels con- 
cerned in the pathological condition ; and secondly, by restoring tone 
to the over-dilated capillaries. 

Friction is another remedy belonging to the division now under con- 
sideration ; and it is one often had recourse to by the surgeon with signal 
benefit. After violent sprains, in which much fluid has been effused 
into the cellular membrane, there is no mode of medication, which oc-zv^ 
casions the absorption of the effused fluid so rapidly as rubbing the part 
with the hand simply dipped in flour, or covered with some liniment. 
The object of dipping the hand in flour is to prevent the abrasion, which 



286 SPECIAL EUTROPHICS. 

would necessarily result from the friction ; and in the generality of cases, 
liniments are of no other service. This, at least, applies to simple 
oleaginous liniments ; but where stimulating substances are added, some 
additional influence may be exerted by them. To produce the full 
sorbefacient effect, in the cases mentioned, the friction must be continued 
for a long time, — for at least half an hour; — and it must be repeated 
as the case may seem to require. In Scotland, there are women, who 
obtain a livelihood by this kind of dry rubbing, and whose celebrity is 
such, that the author has known respectable patients go from a border 
county of England to Edinburgh to be operated on by them. 

From all that has been said, it is clear, that we have, in the class of 
eutrophics, a number of valuable remedial agents, that may be adapted 
for various states of disease, which — as in the case of different cachexies 
— may have resisted other modes of management. 



SPECIAL EUTROPHICS. 

HYDRAR'GYRI PR^PARA'TA.— PREPARATIONS OF MERCURY. 

There are few articles in the lists of the Materia Medica,that are pos- 
sessed of equal interest with mercury ; or that play so important a part 
in the history of medicine ; and although it is considered less essential 
in syphilis, since it has ceased to be regarded as an ' antidote' to that 
malady, it is still one of the most valuable of therapeutical agents. It 
is considered to have been first employed by the Arabians, but 
only as an antiparasitic or destroyer of vermin ; and externally in 
cutaneous affections. Paracelsus is said to have first introduced its in- 
ternal employment. 

When mercurials are given in small and repeated doses, it is speedily 
observed, that tfceir action is exerted on the secretory apparatus; and 
perhaps preceding — certainly accompanying — this action, more or less 
excitement may be detected, if we carefully note the condition of the 
circulatory apparatus. The biliary, salivary, and pancreatic fluids, and 
the fluids of the gastro-enteric mucous membrane, are secreted in larger 
quantity ; the cutaneous and urinary depurations are augmented ; and 
under this increase of the secretions, nutrition becomes modified ; the 
absorbent system appears to be more active, and fluids that have accumu- 
lated in areolar spaces or serous cavities, or solid matters that have been 
deposited so as to constitute hypertrophies of various kinds, disappear 
under its employment. At times, however, a true mercurial fever is 
excited, under which, as under other febrile conditions, the various se- 
cretions are diminished in quantity, and modified in character. When 
carried still farther than this, their peculiar preference for the salivary 
glands and the parts about the mouth is exhibited ; which assume an 
unwonted energy of secretion, so that several pints, in cases of exces- 
sive mercurial pryalism, may be discharged in the course of the twenty- 
four hours. 

The precursory phenomena usually are,— tenderness, tumefaction, 
and pale rosy colour of the gums, except at the very margins, where 



HYDRARGYRI PRiEPARATA. 



287 



they are deep red. The gums gradually fall away from the teeth; and 
a white secretion occupies the portion of the tooth from which they 
have subsided. The mouth becomes sore ; the tongue swollen ; the 
teeth are tender when pressed against each other, and loose ; the breath 
acquires a characteristic fcetor ; and a coppery taste is experienced. In 
this state, the mouth is said to be unequivocally " touched " by mer- 
cury; and it would be well if the effects could, when desired, be thus 
limited. Either from accident or design, they may, however, extend 
much farther; the salivary glands may become tender and tumefied, 
and increase their secretion profusely; and as, when once induced, 
ptyalism is an affection that generally continues unmodified by medi- 
cine, or is self-limited, enduring for days and sometimes for weeks, the 
whole system suffers, partly from the extent of the discharge, but still more 
from the suffering and irritative fever that accompany it. At one time, 
it was supposed, that the mercury is thrown off' in the fluid of the ptya- 
lism ; but careful analysis by skilful chemists has entirely failed in de- 
tecting the smallest particle of the metal in that fluid. 

Such are the phenomena that may be induced by mercury, when 
given for the cure of disease ; and they may be caused at any time, and 
on any one, except on the rare few who are unsusceptible of its action, 
provided the mercury be continued sufficiently long. Some persons 
are unusually impressible to it ; and are salivated by very small quan- 
tities ; and the author has observed, more especially in public practice, 
that particular seasons and local influences have rendered patients ex- 
ceedingly susceptible, so that a few grains of Pilulce Hydrargyri have 
caused salivation ; when, at other times, a long protracted use of a 
more active preparation of mercury would have been required to induce 
the same effect. It has been elsewhere remarked, that it is extremely 
difficult to affect the system of an infant under two years of age, whilst 
at an after period it may be extremely susceptible to its action. Emi- 
nent observers — as Dr. John Clarke, and Messrs. Evanson and Maun- 
sell — have, indeed, affirmed, that they never saw a child under three 
years of age salivated by mercury. It is, doubtless, a very rare occur- 
rence ; but when it has taken place, it has generally been very intracta- 
ble. Dr. J. B. Beck, of New York, gives the case of a child, two years of 
age, salivated by five grains of calomel, administered in three portions 
at intervals within the space of about twelve hours. " When salivation 
does take place in the infant, as it sometimes does, its effects are most 
disastrous. Sloughing of the gums and cheeks, general prostration 
and death are by no means uncommon occurrences ;" — and he infers, 
from the results of his observation and inquiries, that although young 
subjects are salivated with great difficulty, the effects of mercury are 
frequently more energetic and uncertain than they are in the adult. 

Again, there are persons who are salivated whenever they take a few 
grains of calomel. In some constitutions, mercury acts as a true 
poison, causing what has been termed mercurial erethism, or a febrile 
condition characterized by great adynamia ; in which, on the occur- 
rence of some emotion or exertion, the individual may suddenly ex- 
pire. (J. Pearson.) The author saw a fatal case of the kind in which 
mercurial erethism was induced by the application of Unguentum 



SPECIAL EUTROFHICS. 

oxidi rubri to a sore on the leg. In this case, there was, 
|e vesicular eruption to which the name Eczema mercuriak 
tyria has been given, and which is unquestionably induced 
uv im-a^m/ in particular individuals. 

Besides these effects, a train of phenomena, strikingly like those of sy- 
philis, have been ascribed to mercury. To the aggregate of these, the 
names hydrargyriasis, mercurial disease, mercurial cachexy, and, by 
some, pseudo-syphilis,h?Lve been assigned. Amongst them maybe enume- 
rated, — mercurial iritis; sloughing ulceration of the fauces; inflamma- 
tion and caries of bones; periostitis; mercurial tremors, cachexia, &c. ; 
but difficulty in appreciating the precise causes of some of these,— 
whether, for example, they should be ascribed to syphilis or to mer- 
cury — arises from the fact, that mercury has generally been prescribed. 
Some, indeed, affirm, that caries of the bones never occurs in syphilis 
unless where mercury has been given ; but the remark needs confirma- 
tion. 

The consequences of the ptyalism occasioned by mercury are at times 
awful ; — sloughing of the soft parts of the mouth and throat ; loss of 
teeth ; caries of the jaw bones ; adhesion of the cheeks to the gums, 
and ligamentous bands preventing the depression of the lower jaw. 
Awful case of deformity are, indeed, occasionally witnessed from the 
abuse of this potent agent. Formerly, these cases succeeded generally 
to its administration for syphilis: now, we witness them more frequently 
as the sequelae of the treatment of remittent and other fevers, in which 
it is the custom, with some, to administer calomel in excessive quan- 
tities. 

As to the mode in which the effects of mercury are exerted on the 
system, not much difference of sentiment exists. That it is absorbed is 
shown by the fact, that metallic mercury has been discovered in the 
bones and other parts where salts of mercury had been taken freely. 
It has likewise been found in the blood, although it is not easy to detect 
any inorganic substance when it is mixed, as in that fluid, with com- 
pounds of organization ; and that it is given off by transpiration is 
shown by the fact, that a gold watch, worn by one taking mercury, is 
coated with the metal. 

The precise nature of the action of mercury on the animal economy 
has been a matter of dispute. We have seen that it passes into the 
mass of blood; and, doubtless — like eutrophics in general — it modifies 
the condition of that fluid, so that a new action is caused by it on the 
systems of secretion and nutrition ; but of the precise mode in which 
this is accomplished, we know no more than we do of the modus ope- 
randi of other articles of the class, or indeed of any of the classes of 
therapeutical agents. 

It was elsewhere stated, (Vol. i. p. 267,) that mercury has been 
ranked by some amongst sialagogues ; that salivation is one of the re- 
mote effects of its administration ; and that this result is never neces- 
sary, and rather to be deplored, inasmuch as the increased discharge 
exhausts and irritates, without producing the desired benefit. It is 
sufficient if the mouth be ' touched,' and this condition be kept up for 
a sufficient length of time, to have all the benefit, that mercury is capa- 



HYDRARGYRI PRiEPARATA. 289 

ble of accomplishing. To produce this result various methods are 
adopted. Perhaps the best of all is to rub in Unguentum Hydrargyri 
according to the rules advised hereafter. In this way, no danger exists 
of disturbing the bowels; and the only inconvenience is the sustained 
and repeated friction. This friction is usually made on the inside of 
the thigh or of the arm, in consequence of the epidermis being thinner 
there, so that the mercury is more readily forced through it, and comes 
in contact with the absorbents of the true skin. For a similar reason, 
calomel has been rubbed on the inside of the cheeks and gums, care 
being taken not to swallow the saliva, for fear of inducing diarrhoea. 
Calomel, sulphuret of mercury, and the protoxide, have been used in 
the way of fumigation for the same purpose ; and ptyalism has resulted 
from their employment in this manner, after their internal and iatraleptic 
use had been tried in vain. 

After all, however, it is so much more easy to take the remedy inter- 
nally, that in the generality of cases, to produce the full eutrophic effect 
of mercury, this method is adopted,— unless it should act upon the 
bowels, so as to prevent the constitutional effect from supervening. 
The most common preparation prescribed for this purpose is the mild 
chloride, and next to it pilulae hydrargyri. Generally, the effects of the ^v 
mercury will be perceptible on the gums in the course of a few days ; 
but, at times, it is exceedingly difficult to produce any manifestation of 
its action. Should the diseased condition yield under its use this is 
not a matter of moment; but if it be desirable to excite a more decided 
action, remedies may be employed that favour absorption, — such as 
blood-letting and emetics ; under the operation of which mercurialism 
often declares itself speedily ; and occasionally to such an extent as to 
favour the idea that an accumulation may have taken place in the sys- 
tem. Often, after the internal use of mercury has been tried in vain 
its effects are rapidly developed, when inunction is emploved alon^ 
with it. S 

Whilst the patient is under the effects of mercury, his diet should be 
regulated ; and he should be careful to avoid partial and irregular ex- 
posure to cold and moisture. The system is rendered impressible, and 
rheumatic and other disorders have resulted from a neglect of these 
precautions, which have rendered the individual a cripple for life. In 
regard to the treatment to be pursued during the existence of mercurial 
ptyalism, and for the removal of its sequelae, the author must refer to 
another work, (Practice of Medicine, 3d edit., i. 618, Philad. 1848). 

The diseases in which the eutrophic virtues of mercury have been 
witnessed are numerous. Difference of sentiment has existed in regard 
to its use in fevers. At the commencement of none of them is it per- 
haps advisable except as a cathartic; but in after stages, especially 
when mischief exists in any organ, or when the morbid actions appear 
to continue, as it were, from association, the new action, induced by it, 
is often most salutary. It is difficult, however, to affect the mouth in 
these cases, even when the internal use of the remedy is conjoined with 
the external; and it has been affirmed by some, that when we do suc- 
ceed in ' touching' the mouth, it is rather an evidence of the previous 
subsidence of febrile action, than that benefit has been caused bv the 

Vol. II.— 19 J 



290 SPECIAL EUTROPHICS. 

mercury. Howsoever this may be, the occurrence of approaching ptya- 
lism is favourable ; and some observers have affirmed, that death rarely 
takes place after salivation has been once established. The author has, 
however, seen more than one example to the contrary. The routine 
practice in many parts of this country, and in tropical climates, is to 
give calomel in excessive doses from the very commencement of the 
affection. 

In inflammations mercury has been greatly employed, — generally, 
perhaps, as a cathartic ; but often as a eutrophic. It has been elsewhere 
remarked, that large doses of calomel are looked upon as sedative; 
and with this view it has been prescribed in inflammation ; and occa- 
sionally, also, in fever. Attempts have been made to show, that it is 
more advantageous in inflammations of particular organs than of others, 
— in the phlegmasise of serous rather than in those of mucous mem- 
branes, although the contrary has been maintained by some; — that it is 
especially valuable in diphtheritic inflammations, by the power which 
it possesses of diminishing the plastic properties of the blood, — and 
that, therefore, it has been presumed, it may prevent a farther effusion 
of membraniform matter — as in croup — and favour the softening and 
absorption of that which has been already effused ; — that its eutrophic 
action is more exerted upon particular organs, as the liver ; and hence, 
especially after blood-letting, it has been regarded as an admirable remedy 
in hepatitis, acute and chronic — especially in that so common in hot 
climates : — but the same principle is probably at the basis of its benefi- 
cial agency in all these cases. By the new action, which it causes in 
the system generally, and in the secretory and nutritive functions espe- 
cially, it operates as a revellent, and derives from the morbid action 
going on in a part of the organism. We can hardly suppose its effects 
to be exerted in any other manner in syphilis. Scarcely an observer of 
the present day regards mercury as an u antidote" to that affection. It 
has been shown indisputably, that in the large mass of cases, the dis- 
ease is removable without a particle of mercury ; and when mercury is 
considered to be advisable, where the disease is making frightful pro- 
gress, it is freely administered under the belief, — that being a potent 
article and capable of exciting a new and engrossing morbid condition 
of the organism, it may so far interfere with the vice in the system of 
nutrition as to completely change the original morbid condition. It is 
now rarely employed, except in such cases. Some there are, indeed, 
and men of no little weight in the profession, who denounce mercury, 
and affirm that it is unnecessary, and always injurious in every case of 
syphilis ; but the author has seen instances in which nothing but a 
eutrophic remedy, possessed of such potency, was capable of arresting 
the progress of the malady. Iodine and other articles had been tried in 
rVv va in ; and the diseased action subsequently yielded to the establishment 
of mercurialism. Yet these cases, he admits, are rare. 

A remark is necessary regarding the power ascribed to mercury of 
diminishing the plastic properties of the blood. Were it really possessed 
of them we should expect a diminution in the proportion of the fibrin- 
ous element under its use ; yet such is not the fact. M. Andral ex- 
amined the blood in different cases of mercurial stomatitis, and disco- 



HYDRARGYRI PRJEPARATA. 291 

vered an increase in the quantity of fibrin, corresponding to the severity 
of the local phlegmasia. Others have considered, that it diminishes 
the quantity of red corpuscles, which would equally increase the ratio 
of the fibrin. The salutary operation of mercury in the phlegmasia? is, 
therefore, probably dependent wholly upon its revellent powers. 

In almost every form of cachexia, mercury has been administered, 
and, where cautiously given, evil can scarcely result from it. ' Many of 
these cachexia? are accompanied by an impaired state of all the func- 
tions, which the irritation of mercury is calculated to develope ; even 
when the new action induced by it might hold out prospects of benefit 
in respect to certain of the phenomena. Tuberculosis, for example, is 
evidently favoured by impaired or defective nutrition ; and can be 
developed under influences, which are capable of inducing this. Hence, 
if salivation should be produced accidentally or by design, it could 
scarcely fail to prove injurious. In the tuberculous or scrofulous ca- 
chexia, mercury is, therefore, rarely employed ; nor can its full action 
be considered well adapted for the chlorotic, scorbutic, rhachitic, hydro- 
pic, or the cancerous. Still, accidental circumstances may arise in all 
these to render the cautious administration of mercurials advisable ; as, 
for example, where the dropsy is dependent upon, or accompanied by, 
morbid depositions, which require the induction of a new action in the 
system of nutrition. 

When cholera first appeared in this country, much was said of the good 
effects to be derived from the employment of mercury, especially after 
blood-letting had been premised; and perhaps — after all — as much 
benefit was to be expected from such a combination as from any that 
could be devised. Blood-letting was calculated to diminish the excited 
action of the vessels of the lining membrane of the intestines ; and the 
new action, induced by the influence of the remedy, was well adapted 
for arresting it. The disease was, in too many cases, wholly intractable. 
Mercury was, however, often administered to an extent, which admits 
of no adequate justification. Pounds of calomel were given in a single 
case ; and inunction was extensively combined with it. The mortality 
was much alike, however; and we have not sufficient evidence to de- 
termine, that the progress of the disease was materially modified by any 
particular mode of management. 

Wherever a complaint appears endemically, epidemically, or spora- 
dically, and assumes a malignant aspect, and especially if it be accom- 
panied by visceral hyperaemia or inflammation running rapidly to 
disorganization, mercury is had recourse to ; and often judiciously. 
Unless these cases can be arrested by a powerful revellent or eutrophic 
agency, they necessarily proceed speedily to a fatal termination. 

It is impossible to depict every case in which this valuable agent — 
valuable when properly, most injurious when carelessly prescribed — is 
capable of affording benefit. In all chronic affections, characterised by 
morbid depositions or hypertrophies, its use is invoked, unless special 
considerations should seem to forbid it. It has even been recommended 
in paralysis — encephalic paralysis ; and Dr. Pereira states, that he has 
seen hemiplegia, with impaired vision and hearing, headache, and 
cramps of the extremities, recover under its use, after blood-letting, 



292 SPECIAL EUTROPHICS. 

purgatives, &c, had failed. The patient, a young man, was kept under 
its influence for two months. Still, much can scarcely be expected 
from it in the generality of such cases. 

In all the neuroses, it has been used ; and the new condition, induced 
by it, may be beneficial. Such appears to have been the occasional 
result in neuralgia. 

1. HYDRAR'GYRUM.— MER'CURY. 

Metallic Mercury is found either pure, constituting native or virgin 
mercury, and existing in the form of globules in the cavities of other 
ores of the metal, or combined with silver ; but it is chiefly obtained 
from bisulphuret of mercury or native cinnabar ; the principal mines of 
which are at Idria, and at Almaden in Spain ; at Durasno, in Mexico; 
near Azogue, in New Grenada ; and near Huancavelica, in Peru; and 
a rich mine has been discovered in Upper California, midway between 
San Francisco and Monterey. From this it is obtained by distillation 
with iron or lime. Native mercury is separated by distillation from its 
associated impurities. 

Of 314,286 pounds of mercury imported into England in 1831, 
269,558 pounds, according to Mr. M'Culloch, were carried directly from 
Spain; and 13,714 pounds from Gibraltar: of the latter a part was 
derived from Carniola, and a part from Spain; 31,014 pounds were 
imported from Italy ; only 192,310 pounds were retained for home con- 
sumption. It comes to this country chiefly from the Atlantic ports of 
Spain, particularly Cadiz. A considerable portion is also received from 
Trieste. In the year ending September, 1832, the value of the quick- 
silver imported into the United States exceeded two hundred and sixty- 
three thousand dollars ; a large portion of which was again exported to 
Mexico, Chili, and China. (Wood and Bache.) 

The specific gravity of mercury is 13.5: it should be wholly vola- 
tilized by heat, and dissolved without residue, by nitric acid. When 
pure — as it ought to be for pharmaceutical purposes — a globule, made 
to roll over white paper, should leave no trace. Pure sulphuric acid, 
agitated with it at common temperatures, and afterwards evaporated, 
leaves no residue. 

DifTerence of sentiment has existed in regard to the action of metallic 
mercury w T hen swallowed ; but there can be little doubt that it is devoid 
of any on the economy. It is affirmed, indeed, that when it has been 
long retained in the bowels, it has exerted injurious effects; and this is 
possible, owing to the metal becoming oxidized, and uniting perhaps 
with the gastric acids. It has been elsewhere remarked, that a decoc- 
tion of quicksilver has been advised as anthelmintic, but it is probably 
inert. Empirically, large quantities of quicksilver have been given in 
obstinate obstruction of the bowels; and it has been conceived to be 
especially adapted for cases of intussusception ; but it can be of no 
avail in the progressive form ; and could scarcely fail to be injurious in 
the retrograde. Moreover, we have no phenomena by which we can 



HYDRARGYRUM CUM CRETA. 



293 



judge accurately which form exists in any particular case. At the pre- 
sent clay, metallic mercury is never prescribed. 

When applied externally, mercury would seem to have occasionally 
exerted its specific effects upon the system. A fatal case is recorded, 
in which salivation was induced by wearing at the breast, for six years, 
a leathern bag containing a few drachms of liquid mercury, as a prophy- 
lactic against itch and vermin. 

Workers in mercury have been long known to be subject to various 
affections of the nervous system especially; of which one of the most 
remarkable is a form of shaking palsy, mercurial tremor or trembling ; 
and should the workman persist in his occupation, it is apt to end in 
fatal apoplexy or epilepsy. This condition is met with not only in those 
who are engaged in quicksilver mines, but in looking-glass and baro- 
meter makers, &c, and it is not easily removed. Difference of senti- 
ment, however, exists on this point ; for whilst one writer, Dr. Christison, 
states, that the tremors are cured easily, though slowly; another, Dr. 
Pereira, affirms, that he has not seen the least benefit obtained by reme- 
dial measures, although various modes of treatment were tried. One 
of the most striking cases of the effects of mercurial vapour is the 
following. In 1810, the Triumph man-of-war, and the Phipps schooner, 
received on board several tons of quicksilver, which had been saved 
from the wreck of a vessel. In consequence of the rotting of the bags, 
the mercury escaped ; and the whole of the crews became more or less 
affected. In the course of three weeks, two hundred men were sali- 
vated ; two died, and all the animals, cats, dogs, sheep, fowls, a canary 
bird, and even rats, mice and cockroaches were destroyed. The ques- 
tion in these cases arose, whether the mercury, to produce this action, 
were merely in a state of division, or were oxidized ? It has already 
been seen, that metallic mercury appears to be devoid of any action on 
the organism ; and hence it does not seem probable, that when finely 
divided it could exert any. Some, however, think that it is poisonous ; 
others belive, that its action is dependent upon a portion of the metal 
being oxidized. It has been found, indeed, that the vapour disengaged 
from mercury at atmospheric temperatures contains some oxide. 

2. HYDRAR'GYRUM CUM CRETA.— MER'CURY WITH CHALK. 

(Hydrargyr. 3iij ; Creta prceparat. 3v, rubbed together till the glo- 
bules disappear.) The prevalent opinion is, that when mercury is 
triturated with chalk, the metal is merely divided mechanically ; but 
from its effects upon the economy, and for other reasons stated else- 
where, (Vol. i. p. 188,) it is probable, that a portion at least is oxidized. 

The preparation is generally obtained by our druggists from abroad — 
and the author has seen specimens, which were evidently adulterated 
with red oxide of mercury ; and which, in some cases, excited the most 
violent vomiting and purging. 

This is one of the mildest of the mercurials ; resembling blue pill in 
composition and action, but being weaker than it. Eight grains con- 
tain three of mercury. Like blue pill, it exerts its action on the upper 
part of the intestinal canal, and promotes, by continuous sympathy, the 



294 



SPECIAL EUTROPHICS. 



secretion from the liver ; the chalk acting at the same time as an antacid 
It is often administered as a eutrophic in syphilitic affections of child- 
hood; in enlargement of the mesenteric glands; and in all chronic 
affections, in which a mercurial eutrophic may be needed. 

The dose is from gr. v to 3ss at night, or night and morning, in any 
.thick vehicle. The usual dose to children is gr. iij to gr. v. 

The Dublin Pharmacopoeia has Hydrargyrum cum Magnesia, which 
is prepared by rubbing mercury and manna, of each two parts, and 
carbonate (/magnesia, one part, together ; until the globules disappear. 
It is employed in similar cases with Hydrargyrum cum Cretd. It is not 
officinal in the Pharmacopoeia of the United States. 

3. PIL'ULjE HYDRAR'GYRL— MERCU'RIAL pills. 

The mode of forming these pills, and their properties as cathartics, 
have been described elsewhere, (Vol. i. p. 188.) It was there stated, 
that a portion of the mercury probably experiences oxidation; and that 
the therapeutical effects may be dependent upon the oxide. 

When employed to induce the eutrophic effects of mercury, five or 
ten grains may be given night and morning; and be repeated until the 
mouth exhibits its agency. Should it run off by the bowels, a small 
quantity of opium— say one-fourth of a grain— may be added to each 
dose. Suspended by means of mucilage, it was formerly recommended 
by Plenck, and the mixture was called, after him, Plenck's solution. It 
was prescribed by him as an anti-syphilitic. 

4. UNGUEN'TUM HYDRAR'GYRL— MERCU'RIAL OINTMENT. 

(Hydrargyr. $ij ; Mipis gxxiij ; Sevi W] ; rubbed until the globules 
disappear.) The remarks, made on the composition of the preparations 
last mentioned, are equally applicable to this ; which is also called 
Blue Ointment, Blue Unguent, Unction. When properly prepared, it is 
of a bluish gray colour, becoming darker by age, and should afford no 
traces of globules when rubbed on paper. It contains half its weight 
of mercury, but is said to be frequently prepared with a smaller quan- 
tity of the metal ; and in order to communicate to it the requisite shade 
of colour, sulphuret of antimony, indigo, or Prussian blue is sometimes 
intermixed. Occasionally, too, a little sulphur is added, by which the 
extinction of the metal is facilitated. In such cases, the ointment is 
blacker than it ought to be ; and the smell of sulphur is apparent. 

Mercurial ointment has been given internally, in the form of pill ; but 
it possesses no virtues over mercurial pill, and is, of course, a more 
objectionable form for internal administration. It is, therefore, rarely 
employed in this country. It is applied by friction, either alone, or 
associated with some mercurial, when the object is to affect the system. 
With this view, a drachm may be rubbed in on the inside of the thigh 
or arm, for fifteen minutes, night and morning. Where the object is to 
affect the system speedily, it may be applied to blistered surfaces, or be 



HYDRARGYRI OXIDUM NIGRUM. 295 

placed, in addition, in the axillae. When practicable, the friction 
should be made by the patient himself; but if this should not be con- 
venient, or desirable, the attendant may cover his fingers or hands with 
oiled bladder, to prevent himself from becoming affected by the mer- 
curial. Occasionally, a troublesome eruption is brought out by the 
friction. This soon, however, passes away, and in the mean time a 
fresh surface may be chosen. 

Mercurial ointment is employed as a dressing to syphilitic ulcers, and 
is rubbed on various morbid growths to facilitate their absorption. 

A Compound Liniment of Mercury, Linimentum Hydrargyri 
Compositum, is in the London Pharmacopoeia. It is made of Mercurial 
ointment and Lard of each §iv ; Camphor ^j ; Alcohol f.Jj ; Solution 
of ammonia f.^iv. The camphor being first rubbed with the spirit, and 
then with the lard and ointment of mercury, the solution of ammonia is 
added, and the whole is well mixed together. It has been affirmed, 
that it induces ptyalism more readily than common mercurial ointment, 
owing to the presence of the camphor and ammonia ; but it is rarely 
used for this purpose. It is more frequently employed as a discutient 
to tumours ; and in chronic affections of the joints. 

5. EMPLAS'TRUM HYDRAR'GYRI.— MERCU'RIAL PLASTER. 

(Hydrarg. §vj ; 01. oliv., Resin, aa. §ij ; Emplastr. Plumbi, fgj. The 
oil and resin are melted, and, w T hen cool, are rubbed with the mercury 
until the globules are extinguished ; the melted lead plaster is then 
added.) 

Mercurial plaster in its chemical composition is situate like the last 
article. The London College adds a little sulphur to facilitate the 
extinction of the metal ; but the composition becomes, of course, 
changed by it. 

Spread upon leather, this plaster is applied as a discutient to syphi- 
litic and other tumours ; especially to buboes. It is also applied over 
the abdomen in cases of disease of any of the organs of that cavity, 
particularly in chronic hepatitis. In rare cases, the mercury is absorbed ; 
and ptyalism has resulted from it. 

A Plaster of Ammoniacum with Mercury is officinal in the British 
Pharmacopoeias. It is used in similar cases. 

6. HYDRAR'GYRI OX'IDUM NIGRUM.— BLACK OXIDE OF MER'CURY. 

The mode of forming this preparation has been referred to elsewhere, 
(Vol. i. p. 189.) When newly prepared, it is black, or nearly so ; 
but, as met with in the shops, having been exposed to light, it is gen- 
erally olive-coloured ; being partly resolved into metallic mercury and 
peroxide. It is wholly dissipated by a strong heat, and metallic glo- 
bules are sublimed. 

Black oxide of mercury is rarely prescribed internally ; nor is it well 
adapted for internal use, by reason of its uncertain composition. Hence, 



296 SPECIAL EUTROPHICS. 

it has been expunged from the Edinburgh Pharmacopoeia." It is capa- 
ble, however, of exciting the ordinary eutrophic effects of mercury, 
when given in the dose of one grain to three, two or three times a day! 
An ointment is sometimes prepared of it, {Hydrarg. oxid. nigr. p. i. ' 
Adipis p. iij. ;) which may be used in the same cases as Unguentum 
Hydrargyri. It fs a better preparation as a fumigating agent to syphi- 
litic ulcers than the sulphuret, which is more frequently, however, em- 
ployed, in consequence of sulphurous acid being formed when the 
sulphuret is used ; which may be irritating. To induce salivation it 
was employed by Mr. Abernethy in the following manner. Place the 
patient in a vapour bath, in a complete suit of under garments, with a 
cloth around his chin. Two drachms of the oxide are then put on a 
heated iron within the machine in which the patient is sitting. After 
continuing the bath for about fifteen or twenty minutes, the body is found 
covered with a whitish powder. The patient should now be placed in 
bed ; lie in the same clothes till morning, and then go into a tepid bath. 
Mr. Abernethy affirms, that in this manner he has known salivation pro- 
duced in forty-eight hours. 

It is the basis of the well-known Black wash, {Hydrarg. chlorid. mil 
5ss ; Liquor, calcis Oss.) In this case, the black oxide is precipitated ; 
and chloride of calcium remains dissolved. It is much used as a wash 
for syphilitic sores. 

7. HYDRAR'GYRI OX'IDUM RUBRUM.— RED OXIDE OF MER'CURY. 

Red <aidc, Binoxide, Deutoxide, Peroxide of mercury, Red precipitate, 
is prepared by dissolving mercury, with a gentle heat, in nitric acid pre- 
viously mixed with water, and evaporating it to dryness. The mass 
is then rubbed into powder, and heated in a very shallow vessel, till red 
vapours cease to arise. The dry mass, first obtained, is nitrate of per- 
oxide of mercury, the nitric acid of which is decomposed and driven 
off by the heat ; and by continuing the process till ruddy fumes of 
nitrous acid cease to be disengaged, the red oxide is obtained pure. It 
is in orange-red crystalline scales, which are wholly soluble in chloro- 
hydric acid. On the application of heat, it yields oxygen ; and the 
mercury either runs into globules or is wholly dissipated. 

Red oxide of mercury is so powerful, an irritant, and so harsh and 
uncertain in its action, that it is very rarely prescribed internally. 
It has been used as a eutrophic in syphilitic cases, in the dose of from 
a quarter of a grain to a grain, associated or not with opium. Exter- 
nally, it is applied in the form of powder, in syphilitic and other slug- 
gish ulcers ; or made into an ointment. It is the basis of the Yellow 
wash, Phagedenic wash, much used in syphilitic and sluggish ulcers, 
and applied by means of lint wetted with it. (Hydrarg. chlorid. cor- 
rosiv. gr. xv ; Liquor, calcis Oss.) 

The red oxide is occasionally used to destroy pediculi. 

UNGUENTUM HYDRARGYRI OX'IDI RUBRI. OINTMENT OF RED OXIDE OF MER'- 
CURY. {Hydrarg. oxide, rubr., in pulv. subtiliss. §j ; Unguent, simpl 



HYDRARGYRI CHLORIDUM MITE. 297 

§viij.) This ointment undergoes a change of colour and character by- 
being kept ; its beautiful red colour is changed to a black, owing to the 
deoxidation of the red oxide of mercury. It is a common application 
to syphilitic and other indolent sores, in which it appears to act simply 
by its excitant properties. It is likewise used as an excitant in ophthal- 
mia tarsi ; and may be employed at night by means of a camel's hair 
pencil. The gluing together of the tarsal edges of the eyelids is, in 
this way, prevented. It is, likewise, much used in porrigo, and other 
chronic cutaneous eruptions. 

Red oxide of mercury is used in the preparation of Hydrargyri 
Cyanuretum of the Pharmacopoeia of the United States. 

8- HYDRAR'GYRI CHLO'RIDUM MITE.— MILD CHLORIDE OF MER'CURY. 

Mild chloride of mercury or calomel — whose general properties are 
described elsewhere, (Vol. i. p. 186,) — is capable of exerting all the 
effects of the mercurials, and is more used in this country for that pur- 
pose than any other preparation. It is astonishing, indeed, how much 
of this agent has been given almost, if not altogether, empirically in for- 
midable diseases, as in cholera. It would seem to exert no irritating 
agency in enormous doses ; for where an ounce was taken by mistake, 
the only effects were slight nausea and faintness, and neither salivation 
nor any approximation to it followed. It has been administered in 
three drachm doses, often repeated ; and has appeared, in such quanti- 
ties, to be sedative rather than irritant. It is a common idea, that these 
huge doses have only been given in the western and southern parts of 
the United States ; but such is not the fact. " I have now before me," 
says Dr. Pereira, " reports of eighteen cases of spasmodic cholera, ad- 
mitted in the year 1832, into the Cholera Hospital at Bethnal Green, in 
this metropolis, (London,) in which enormous quantities of calomel 
were employed by the house-surgeon, Mr. Charles Bennett, (formerly 
one of my pupils,) with very slight physiological effects. When a pa- 
tient was brought into the hospital, two drachms of calomel were im- 
mediately given, and afterwards one drachm, every one or two hours 
until some effect was produced. In 17 out of 18 cases in which this 
plan was tried, the vomiting and purging diminished, and the patients 
recovered. Several of them took from 20 to 30 drachms without the 
subsequent ptyalism being at all excessive. In one case (a female, 
aged 36 years,) 30J drachms were administered within forty-eight 
hours; moderate ptyalism took place and recovery. In the unsuccess- 
ful case, which I have alluded to, 53 drachms of calomel were admi- 
nistered within forty-two hours, without the least sensible effect." 

As a gentle eutrophic, calomel is prescribed in very small doses, half 
a grain for example, night and morning, in diseases of the glandular 
system ; and in chronic cutaneous and other affections, that demand an 
alterative agency. It is likewise given in small doses, like blue pill, fol- 
lowed by a cathartic, in hepatic diseases; in which it probably operates, 
by revulsion, in two modes ; first, through its peculiar excitant agency 
on the lining membrane of the stomach and duodenum; (see Vol. i.p. 



298 SPECIAL EUTROPHICS. 

186 ;) and secondly, through its insensible action on the secretory system 
in general. When prescribed even in the small doses above mentioned, 
it speedily produces its peculiar effects on the system. To accomplish 
this, however, it is generally associated with opium, to prevent its affec- 
ting the bowels. The following form is often employed by the author in 
syphilis ; — Hydrarg. chlorid. mit. gr. vj ; Pulv. opii gr. iij; Cretce prceparat. 
3} * Con feet. ros. q. s. ut riant pilulae xij. Dose, one night and morn- 
ing, until the mouth is slightly affected. Occasionally, however, it is 
given much more freely and more frequently ; where the desire is to 
produce speedily full ptyalism ; but the author has generally found, that 
small quantities given at long intervals — not less than four or five hours 
— touched the mouth sooner than when it was administered oftener ; 
and to a greater extent. It has been maintained, indeed, by one ob- 
server, that when given every three or four hours, in doses of five or 
six grains, it is exceedingly difficult to salivate with it ; as the mercury 
passes off' rapidly by the skin. 

Calomel is sometimes used as a local application, being suspended in 
mucilage, and employed as a gargle in syphilitic sore throat ; but more 
frequently used in the form of ointment in syphilitic sores ; and like- 
wise as a local application, to induce a new action in various chronic 
cutaneous diseases. Dr. Pereira states, that were he required to name 
a local agent pre-eminently useful in skin diseases generally, he would 
fix on this; — Hydrarg. chlorid. mit. 3j ; Mipis ^j. It certainly is a 
good application in these cases ; but the author has not been led to esti- 
mate it so highly. 

9. HYDRAR'GYRI CHLCRIDUM CORROSI'VTJM.— CORROSIVE CHLORIDE OF 

MERCURY. 

Corrosive Chloride, Corrosive muriate, Bichloride, Muriate or Oxy- 
muriate of mercury, Corrosive sublimate, is made by boiling Mercury 
with Sulphuric acid, until the sulphate of mercury is left dry. When 
cold this is rubbed with chloride of sodium, and sublimed. In this pro- 
cess, double decomposition occurs, — the products being bichloride of 
mercury which sublimes, and sulphate of soda which remains behind. 

As usually met with, it is in colourless crystals, or crystalline masses, 
which sublime without leaving any residue ; and are entirely soluble in 
water, alcohol and ether. Its solubility in water is variously stated. It 
requires, however, about three times its weight of boiling water, and 
eighteen or twenty times its weight of cold water. Its solubility is 
increased by the acids, especially the chlorohydric ; and by the alkaline 
chlorides ; hence, muriate of ammonia is occasionally added to lotions 
of which it forms part. 

Corrosive chloride of mercury is a most virulent corrosive poison, 
acting as a powerful caustic by reason of its affinity for the albuminous 
and other constituents of animal matters. In smaller doses, it is em- 
ployed therapeutically as a eutrophic; and in syphilitic diseases is pre- 
ferred by some — exerting often a beneficial effect upon them, without 
salivation or any other disagreeable result. Occasionally, indeed, it 



HYDRARGYRUM AMMONIATUM. 299 

irritates the gastro enteric organs, producing nausea, tormina and purg- 
ing ; but this may generally be obviated by administering it carefully, or 
by combining it with opium. It is less likely to produce salivation than 
any other mercurial ; and this is one cause of its being so extensively 
employed in syphilis, — concealment being important, and salivation 
leading to strong suspicion of the nature of the affection, for which it 
has been prescribed. 

It may be given in every stage of syphilis, but has had more reputa- 
tion in the secondary form, and especially in chronic cutaneous aff'ec- i^" 
tions of a venereal kind. In such cases, it may be prescribed either in 
the form of pill made with crumb of bread, or in solution, — from l-16th 
to l-12th of a grain for a dose, repeated three or four times a day, and 
taken on a full stomach ; or in the form of the officinal solution given 
below. It is frequently combined with sarsaparilla, and other vegetable 
eutrophics, not only in syphilitic affections, but in rheumatic and neu- 
ralgic conditions, and in chronic cutaneous diseases in general ; and it 
certainly often succeeds in modifying the morbid state of the nutritive 
actions of the part, after they have resisted other remedies. Externally, 
it is used occasionally as a gargle in venereal sore throat ; as a wash to 
syphilitic ulcers ; and in different chronic cutaneous diseases ; as well 
as in ophthalmia of a venereal nature. The strength of the lotions \\y 
may vary from half a grain to two or three grains to the fluidounce. It 
may be applied to the throat by means of a camel's hair pencil. 



10. HYDRAR'GYRUM AMMONIA'TUM— AMMO'NIATED MER'CURY. 



Ammoniated mercury, ammonio- chloride of mercury, muriate of am- 
monia and mercury, cosmetic mercury — more commonly known under 
the names, white precipitate of mercury, white precipitate — is prepared 
by dissolving corrosive chloride of mercury in distilled water, with the 
aid of heat ; and, when the solution is cold, adding solution of ammonia. 
The precipitate — when washed till it is tasteless, and dried — is ammo- 
niated mercury. 

As met with in the shops, it is in powder or in pulverulent masses, 
of a white colour ; without smell, and of a taste which is at first earthy, 
and afterwards metallic. It is insoluble in water and alcohol. 

Ammoniated mercury is never used at the present day internally. 
In the form of ointment, it is applied to chronic cutaneous eruptions ; 
and as an excitant to ulcers, especially when of a syphilitic character. 
Either in the form of an ointment, or rubbed up with hair powder, in 
the proportion of one part of the ammoniated mercury to four parts of 
powdered starch, it is used to destroy pediculi. 

UNGUEN'TUM HYDRAR'GYRI AMMONIA'TI, OINTMENT OF AMMONIATED MER'CURY. 

(Hydrarg. ammonmt. 3j; Unguent, simpl. |iss.) Used in the cases 
just mentioned. 



300 SPECIAL EUTROPHICS. 



11. HYDRAR'GYRI IOD'IDUM.— I'ODIDE OF MER'CURY. 

Iodide, Protiodide or Subiodide of mercury, is made by rubbino- mer 
cury and iodine together in certain proportions, with sufficient alcohol to 
form a paste ; and continuing the trituration until the globules disappear 
The iodide is then dried in the dark, with a gentle heat ; and kept in a 
well stopped bottle, whence the light is excluded. The mercury in 
this process, combines with the iodine, and the combination is fac'ili 
rated by the alcohol, which dissolves a part of the iodine, and form, 
the remainder into a paste. 

It is a greenish-yellow powder, which is insoluble in water or alcohol 
but is soluble in ether, and slightly so in a watery solution of iodide of 
potassium. 

It is a powerful irritant poison; but in small therapeutical doses is 
capable of exciting the ordinary alterative and sialogogue efTects of the 
mercurials. By some, it has been supposed to be especially efficacious 
in cases in which there is a union of scrofula and syphilis- but 
according to Dr. Christison, "all hitherto positively known relative to 
these notions is, that iodide of mercury is capable of producing the 
physiological effects of mercurials. It has been given in syphilis and 
in scrofula, and especially when occurring together; and in chronic 
cutaneous affections of various kinds." It is not, perhaps, so often 
used in this country as the red iodide. 

The London Pharmacopoeia contains two preparations,— Pilule Hy- 
drargyri Iodidi ; {Hydrarg. iodid. 5j ; Confect. rosce canin. Juj ; Zingib. 
pulv. 5j. Five grains contain one of iodide;) and Unguentum Hy- 
drargyri Iodidi ; (Hydrarg. iodid. §j ; Ceres albce 5ij ; Mips 5vj,) 
which is employed as a dressing for scrofulous ulcers, or for syphilitic 
ulcers in scrofulous individuals; and likewise as an application in 
lupus, and other congenerous affections of the skin. 

The dose of iodide of mercury is a grain, which may be gradually 
carried to three or four. ° ; 

12. HYDRAR'GYRI IOD'IDUM RUBRUM.-RED I'ODIDE OF MER'CURY. 

Red iodide, Biniodide, Deutiodide or Periodide of mercury, is made by 
dissolving corrosive chloride of mercury, and iodide of potassium, in 
proper proportions, in water; mixing the solutions; collecting the pre- 
cipitate on a filter, and, having washed it with distilled water, drying 
it with a moderate heat, and keeping it in a well stopped bottle. In 
this process, chloride of potassium remains in solution ; and the red 
iodide is precipitated. 

It is of a beautiful scarlet red colour; is insoluble in water, and 
sparingly soluble in alcohol, but very much so in certain saline solu- 
tions, of which those of iodide of potassium, and corrosive chloride of 
mercury are most remarkable. With other alkaline iodides-as iodide 

of fiSSS^T a ChSS ° f d ° Uble SaltS ' C3l,ed ^argyro-iodides, 



HYDRARGYRI SULPHURETUM NIGRUM. 301 

In its therapeutical effects, this preparation resembles corrosive 
chloride of mercury, whilst the iodide resembles calomel. It may be 
given in the same cases as the iodide, but requires great caution in its 
administration. The author has frequently administered the red iodide 
in public and in private practice, in cases where an active modifier of 
the function of nutrition appeared to be demanded, and where a combi- 
nation of the potent remedies — mercury and iodine — suggested itself. 
In chronic glandular enlargements, especially of the liver and spleen, 
and in habits where the use of mercury was not contra-indicated, both * h s*'^ 
it and the iodide have proved serviceable. Perhaps there are no prepa-- 7 
rations, which, under the circumstances in question, merit more atten- 
tion. It readily excites ptyalism. 

It may be given internally in the dose of one-sixteenth gradually in- 
creased to one-fourth of a grain, in the form of pill ; or it may be dis- 
solved in alcohol, (Hydrarg. iodid. rubr. 9j ; Alcohol, ^iss. Dose, ten ^ 
to twenty drops ;) or in ether, (Hydrarg. iodid. rubr. 9j ; JEther. sul- ' 
phuric. f.^iss. Dose, ten to twenty drops.) 

In the form of ointment, it has been found very efficacious in scro- 
fulo- venereal ulcers, syphilitic swellings of the lymphatic glands ; 
scabies ; carcinomatous ulcerations ; goitre, condylomata, &c. The 
London Pharmacopoeia has Unguentum Hydrargyri Biniodidi, (Hy- 
drarg. iodid. rubr. ^j ; Ceras flavas ^ij ; Adipis ^vj.) the strength of 
which requires to be reduced, when applied to delicate parts, or to 
painful ulcerations. 

13. POTAS'SII I'ODO-HYDRAR'GYRAS.— I'ODO-HYDRAR'GYRATE OF 

POTAS'SIUM. 

Iodo-hydrar gyrate of potassium, Hydrar gyro-iodide, of potassium , 
lodo-hydrar gyrate of loduret of potassium, Hydrar gyro-iodide of potas- 
sium, may- be made for medical use in the following manner — Hydrarg. 
iodid. rubr. gr. iv ; Potassii iodid. 9j ; Aquce destillat. f.^j. Dose, five 
drops, three times a day. By the union of the two -iodides, a soluble 
double salt is formed, in which red iodide of mercury acts the part of 
an acid, and iodide of potassium that of a base. 

It does not appear, that this preparation possesses any essential, or, 
indeed, any advantage over the iodides of mercury ; and accordingly 
it is not much used. It may be prescribed in the same cases. 

14. HYDRAR'GYRI SULPHURE'TUM NIGRUM.— BLACK SULPH'URET OF 

MER'CURY. 



Black sulphuret of mercury, Sulphuret of mercury with sulphur, 
JEthiop's mineral, is made by rubbing together equal quantities of 
mercury and sulphur till the globules disappear. It is a black, tasteless 
powder; devoid of smell, and insoluble in water. It is wholly dissi- 
pated by heat. 

Black sulphuret of mercury is a feeble mercurial, and is rarely ad- 
ministered so as to affect the system with mercury. It has been given, 



*-■* 



302 SPECIAL EUTROPHICS. 

indeed, in considerable doses, and for a great length of time, with 
scarcely any effect. When prescribed at all, it is generally in the 
glandular affections of children ; and in chronic cutaneous diseases, 
especially in scabies, in which the sulphur is probably the most active 
ingredient. Its dose is from gr. v to 3ss repeated two or three times a 
day. 

15. HYDRAR'GYRI SULPHURE'TUM RUBRUM — RED SULPH'URET OF 

MERCURY. 

Red sulphuret or Bisulphuret of mercury ', Cirmabar or Vermilion, is 
made by mixing mercury with melted sulphur, in due proportions, over 
the fire ; rubbing the mass, when it begins to swell, into powder ; and 
subliming. By the agency of heat, the mercury and sulphur unite and 
form black sulphuret ; which is converted by sublimation into red sul- 
phuret. 

Cinnabar occurs in nature, but is never used for therapeutical pur- 
poses. That of the shops is always prepared in the mode above-men- 
tioned. It is met with in two forms, — in mass, when it is a ponderous 
dark brownish-red substance of metallic brilliancy, very friable, and 
leaving a vermilion streak when scratched with the nail, — and in 
powder, when it is likewise heavy, and of a well known red colour. 
It is devoid of taste and smell, and is entirely volatilized by heat. 

Red sulphuret of mercury may be used in the same cases as black 
sulphuret, but it is rarely given internally. It is most commonly em- 
ployed as a fumigating agent in syphilitic affections of the throat. Half 
a drachm may be thrown upon a hot plate, and be received into the 
fauces by breathing over it. In this manner it not only produces local 
excitations; but salivation where it is desirable that this should be 
caused speedily. Ptyalism, thus induced, has at times been so violent, 
that the remedy is rarely used. The sulphurous vapour, too, is so irri- 
tating as to be improper for those of weak lungs ; and the black oxide 
is preferred where fumigations are considered to be advisable. 

Should it be desired to give it internally ; from ten grains to half a 
drachm may be prescribed. 

16. HYDRAR'GYRI CYANURE'TUM.— CYAN'URET OF MERCURY. 

Cyanuret of mercury, Bicyanide or Prussiate of mercury, is prepared 
by boiling together ferrocyanuret of iron, red oxide of mercury, and 
distilled water, in proper proportions, for half an hour; and filtering. 
The residue is washed with distilled water, and again filtered. The 
solutions are then mixed, and evaporated, so that crystals may form. 
These may be purified by solution and recrystallization. In this pro- 
cess, the cyanogen of the ferrocyanuret of iron combines w T ith the 
mercury of the red oxide ; and the iron unites with the oxygen of the 
oxide. m m 

Cyanuret of mercury is in transparent crystals, which are square 
prisms, and wholly soluble in water, but very little so in alcohol. They 
are devoid of smell, but have a strong metallic taste. 



UNGUENTUM HYDRARGYRI NITRATIS. 303 

This preparation has been used as an antisyphilitic, and by some 
is preferred to the corrosive chloride, in consequence of its greater 
solubility, and the capability of more speedily affecting the system by it. 
It is said to be liable to excite vomiting ; and, therefore, it is advisable, 
that a small quantity of opium or a few drops of laudanum should be 
added to each dose. Some, however, have not deposed favourably in 
regard to it; whence it has been inferred, that there must be some un- 
certainty in its preparation. It has been used externally in the form of 
ointment, (Hydrarg. cyanuret. gr. xij ; Adipis jfj ;) in chronic cutaneous 
affections, and in syphilitic ulcerations; and has been employed as a 
gargle in syphilitic sore throat. {Hydrarg. cyanur. 9ss ; Decoct, sem. 
lini Oj.) 

The dose is one-sixteenth of a grain, gradually increased to half a 
grain, three or four times a day ; made into a pill with crumb of bread ; 
or, it may be given in solution. The Liqueur antisyphilitique of Chaus- 
sier is made as follows : — Hydrargyr. cyanuret. gr. viij ; Aquae destillat. 
Oj. Each fluidounce contains half a grain of the cyanuret. 

17. UNGUEN'TUM HYDRAR'GYRI NITRA'TIS.— OINTMENT OF NITRATE OF 

MER'CURY. 

Ointment of nitrate of mercury, Citrine ointment, is formed as fol- 
lows : — Hydrarg. 3j ; Acid, nitric. f.3xj ; 01. bubuli f.^ix ; Jidipis 3iij. 
The mercury is dissolved in the acid ; and to the melted lard and oil 
the solution is added. This ointment is said to have been proposed 
originally as an imitation of a nostrum well known by the name of 
Golden eye-ointment. 

When freshly prepared, this ointment has a beautiful golden yellow 
colour ; a soft consistence, and a nitrous odour; but in process of time 
it acquires a dirty greenish hue, and becomes so hard as to be unfit for 
use, unless mixed with lard. This appears to be owing to the harden- <— - <c 
ing of the olive oil by the nitrate of mercury. To diminish this objec- 
tion, neat's foot oil is substituted in the Pharmacopoeia of the United 
States with advantage. Dr. Wood, of Philadelphia, states, that he had 
in his possession for more than a year a pot of ointment, made accord- 
ing to the above process, and although it had partially assumed a 
greenish colour, it preserved a uniform, soft, unctuous consistence. It 
ought not to be stirred with an iron spatula, or be brought into contact 
with iron in any manner ; as the iron will be corroded, and the ointment 
be discoloured. 

Ointment of nitrate of mercury is a valuable application in many 
chronic cutaneous diseases, — as lupus, porrigo, herpes, psoriasis, impe- 
tigo, lepra, &c. It is frequently, also, used in cases of ophthalmia tarsi, 
applied by means of a camel's hair pencil ; and is spread upon lint as 
an application to syphilitic and other foul and phagedenic ulcers. Ex- 
cept in the last cases, however, the ointment generally requires to be 
reduced with at least one or two parts of lard. 



304 SPECIAL EUTROPHICS. 



IS. HYDRAR'GYRI SULPHAS FLAVUS.— YELLOW SULPHATE OF MER'CURY. 

This preparation— the general properties of which have been described 
elsewhere, (Vol. i. p. 123,) — has been given as an alterative mercurial 
in chronic cutaneous affections ; and in syphilis, to produce the specific 
effects of mercury ; but it is at times harsh in its operation. It is now 
therefore, almost abandoned ; and has been pronounced by Dr. Christi- 
son an unnecessary mercurial ; and one that may be expunged from the 
Pharmacopoeias without inconvenience. 

The dose, as a eutrophic, is from a quarter to half a grain ; made 
into a pill with crumb of bread. 

IOD'lNI PR^PARa'tA. — PREPARATIONS OF IODINE. 
19. IOD'INUM.— I'ODINE. 

This article constitutes one of the most important gifts from chemistry 
to therapeutics. It was totally unknown until 1812 ; when M. Courtois, 
a manufacturer of saltpetre, discovered it ; but it was mainly through 
the labours of Gay-Lussac and Sir Humphry Davy, that its chemical 
relations were duly appreciated. Since then, it has been found to be 
very largely distributed in nature ; having been discovered in a great 
number of vegetables belonging to the family Algae ; in many marine 
mollusca, in sea-water, and in several mineral-waters. In Great Britain, 
it is said to be exclusively manufactured at Glasgow, from the kelp of 
the west coast of Ireland, and the Western Islands of Scotland. 
(Pereira.) According to Dr. Traill, the greatest quantity is produced 
by kelp made from drift weed, which is in a great measure composed of 
Fucus digitaius, and F. Loreits, — Cutweed, which consists of F. vesicu- 
losus and F. serratus, yielding much less of it. One hundred tons of 
Caithness kelp, furnish, according to the experience of a manufacturer, 
1000 pounds of iodine, or about a 224th part. (Christison.) It is always 
prepared on a large scale ; and hence is placed in the Materia Medica 
list of the Pharmacopoeia of the United States. It is procured from the 
mother-water of soda derived from sea-plants, by different processes in 
different manufactories. A certain portion of it is readily obtained by 
heating the liquid with sulphuric acid, which decomposes the iodide of 
the alkali ; and violet fumes of iodine are disengaged, which may be 
condensed in a receiver. For the process the reader is referred to the 
various works on chemistry. 

Iodine is in crystalline scales ; of a bluish-black colour, and metallic 
lustre. When heated it melts, and is volatilized in purple vapour; . 
whence its name — from t w% " blue." It is wholly soluble in alcohol 
and in ether; and is very slightly soluble in water, requiring 7000 parts 
of that fluid. Its great characteristic property is the production of a 
blue colour when it meets with starch. In consequence of its high price, 
it is very liable to adulteration ; and it is said, that coal, black lead, 
oxide of manganese and charcoal have been added to it; but neither 



IODINUM. 



305 



Dr. Christison nor Dr. Pereira has met with any of these impurities, 
which remain behind when heat is applied, and admit, therefore, of easy 
detection. Water is the chief adulterant ; and its unusual presence 
may be suspected, if the iodine adheres to the sides of the bottle in 
which it is kept. Dr. Christison states, that until within the last 
eighteen months, he has not met with any British iodine that has not 
contained between 15 and 20 per cent, of water. From July 1848 to 
April 1849 inclusive, Dr. Bailey, inspector of drugs at the port of New 
York, had to reject 3775 oz. of iodine from London, and 1280 oz. from 
Glasgow. The smell of iodine is similar to that of chlorine, with which 
it accords in its property of destroying vegetable colours. It stains the 
skin yellow, but the stain gradually disappears. 

In regard to the effects of iodine on the economy, discrepancy exists 
amongst observers ; although great care appears to have been taken in the 
experiments. Those of MM. Magendie and Orfila would seem to show 
it to be an irritant to man in moderate doses; but, on the other hand, 
Dr. Gully affirms, that he gave as much as f.3iij of the tincture daily, 
and did not observe any effect ; and Dr. Kennedy, of Glasgow, gave 
953 grains in the form of tincture within eighty days, without the 
health of the patient — a girl — seeming to be affected by it. It is cer- 
tainly, however, an irritant when applied topically ; staining the surface 
yellow, as before remarked, and causing rubefaction, itching and des- 
quamation. When inhaled, it acts as an excitant expectorant. (See 
Vol. i. p. 258.) 

Like eutrophics in general, it passes into the mass of blood, and 
exerts its action on the tissues by the modifications induced by it in that 
fluid. That it is received into the blood admits of positive proof. It 
has been detected in the urine, sweat, saliva, milk and blood ; and in 
every case, was found in the state of iodide ; so that M. Cantu infers 
its action on the body to be chemical by abstracting hydrogen. Two 
drachms, according to Dr. Buchanan, were given to a young man labour- 
ing under blennorrhea, and as soon as the medicine made its appear- 
ance in the urine, blood was drawn from the arm. On examining it, 
both the serum and the crassamentum were found deeply impregnated 
with iodine. The same quantity was given to a boy affected with 
dropsy of the knee-joint. About five hours after it had been taken, a 
very small puncture was made, and upwards of twelve ounces were 
drawn off by a cupping-glass. The fluid contained iodine in abun- 
dance. To an old man, who had a very large hydrocele, two drachms of 
iodide of potassium were given over night ; and the same quantity the 
following morning. On tapping him, some hours after he had taken 
the last dose, more than thirty ounces of serum were drawn off, con- 
taining a large quantity of iodine. It has been found in the liquor 
amnii of a female during parturition, who, for four months previously, 
had taken iodide of potassium ; and Landerer detected it in the testicle 
of a man to whom he had administered it. 

When iodine is continued for a length of time, it is said to produce 
a train of phenomena indicating its injurious action on the organism, to 
which the terms iodosis, iodinia, and iodism have been applied. Ob- 

Vol. II.— 20 



306 SPECIAL EUTROPHICS. 

servers have not agreed as to the precise phenomena that characterize 
this condition ; but most of them mention irregularity in the functions 
of the digestive organs ; at times, diarrhoea ; at others, constipation ; 
gastrodynia ; violent vomiting ; excessive emaciation ; anxiety ; de- 
pression of spirits, and symptoms similar to those of hypochondriasis; 
obscurity of vision ; hardness of hearing ; palpitations ; tremors ; ab- 
sorption of the mammae of the female, and of the testes in the male; 
— yet Dr. Buchanan affirms, that although he has given iodine very 
largely, he has never seen any of the unpleasant results that have been 
ascribed to it. He asserts, that he has never seen its use " followed by 
wasting of the testes or mammas ; by palpitations ; faintness ; excessive 
debility ; hurried, anxious breathing ; dinginess of the surface ; copious 
clammy sweats ; increased menstrual discharge, or an oily appearance 
of the urine, which are enumerated amongst the symptoms character- 
izing the supposed affection, termed iodism." From the testimony, 
however, of observers of eminence, we can scarcely doubt, that such 
an affection may be induced, and become dangerous to life ; yet it must 
be rare ; for although the author has administered iodine very freely, 
he has seldom seen symptoms ensue, which he was disposed to refer to 
it ; except such as so nauseous an article was likely to cause in the 
stomach. As respects the wasting of the mammae and the testes, it 
must be unfrequent. Neither Magendie nor Pereira nor Ricord nor 
Kluge — the two last of whom have given it very largely in the hospitals 
of Paris and Vienna — has seen it; but Magendie remarks, that it is 
common in Switzerland. The author's own experience coincides with 
that of the first named gentlemen. He has prescribed it, and seen it 
prescribed largely, both in public and private ; yet no such result has 
supervened in a single instance. M. Lugol, indeed, asserts, that his ema- 
ciated patients became fatter under its use ; and MM. Coindet andFor- 
mey found it increase the appetite. Ulceration of the mouth, and sali- 
vation, are said to have been produced by it. 

As a valuable eutrophic, iodine exerts its power in various diseases, 
— not only when given in its pure state, but in its combination with the 
alkalies — especially the iodide, and the ioduretted iodide of potassium. 
The therapeutical remarks that apply to the one, are equally applicable, 
therefore, to the others. 

Perhaps in no disease have its virtues been more marked than in 
goitre, in which it has been more successful than any other remedy. In 
another work, the author has referred to many individuals who have 
deposed to the valuable services it has rendered ; and it may be added, 
that Mr. Bramley, whilst in Nepal, amongst the Himalaya mountains, 
and under unfavourable circumstances, cured 57 out of 116 cases, and 
brought 34 more into a fair way towards ultimate recovery. (Chris- 
tison.) The author has succeeded in every case of soft goitre in which 
he has prescribed it: in two or three, the hypertrophy returned, but it 
was again dispersed under the use of the remedy. When the tumour 
has acquired a cartilaginous hardness, although it may be diminished 
under the use of iodine, it can rarely or never be wholly removed; but 
under such circumstances, every other remedy would be found equally 
fruitless. Generally, it exhibits its effects in three weeks ; but, at times, 



IODINUM. 307 

not until it has been persevered in for four or five ; after which the im- 
provement is often signal. It may be given either in the form of the 
tincture, or of Lugol's solution ; and may be rubbed on the part at the 
same time ; but the author has always found the tincture sufficient. It 
has been advised by some, that bleeding should be practised ; and if 
little or no effect appears to be produced by the iodine, this may be 
desirable with the view of facilitating absorption ; but it is not usually 
necessary. It is worthy of recollection, that burnt sponge was long 
celebrated f©r its powers over goitre, before iodine was discovered ; and 
the same was the fact in regard to certain brine springs — as that of Salz- 
hausen. 

In the enlargement of other glandiform bodies, — for example, of the 
spleen and mesenteric ganglions ; as well as of different glands, as the 
liver, mammae, testes, submaxillary gland, &c, iodine has been used 
freely; and although the benefits derivable from it are not as marked as 
in goitre, they have often been considerable. 

In scrofulosis, it has attained great celebrity. Whilst mercury has 
been esteemed, by some, the great remedy for syphilis, they have 
equally given the preference to iodine in scrofula ; and, in many forms 
of this cachexia, it is often very successful ; but it requires to be perse- 
vered in for a considerable time. It has been equally celebrated in theft*- 
constitutional forms of syphilis ; and in mercurial cachexia ; in which 
cases iodide of potassium, in large doses, is usually preferred. In 
tuberculous cachexia, it has had testimonials in its favour ; but, like 
every other remedy, it must generally fail in that intractable condition, 
especially as we meet with it in tubercular phthisis. In such cases, it 
has been not only given internally, but has been inhaled in the man- 
ner described elsewhere, (see Vol. i. p. 258) ; but, as the author has 
remarked, his experience has not been favourable to it. It. has likewise 
been given largely in cancerous cachexia, and especially in cancer of 
the uterus ; but although its revulsive influence has seemed, occasion- 
ally, to check the disease for a time, it has almost always — if not always 
— recurred. In dropsy, it has been often given in consequence of its 
manifest influence, in many cases, in modifying nutrition, and thereby 
occasioning absorption. It would seem to be especially indicated in 
cases of dropsy that are dependent upon induration or other organic 
disease of some viscus, as of the liver. Some have affirmed it to be an 
excellent antihydropic in every form of the disease— hydrothorax, ascites, 
hydrocele, hydrocephalus — acute or chronic, hygroma, &c, administered 
internally or applied externally. Of its utility in nervous diseases, tes- 
timony is somewhat discordant ; but in almost every form of cutaneous! 
affection, it has been highly extolled by many ; and spoken doubtfully \ M 
of by some. In these cases, the internal should be associated with the/ 
external use. The iodine, by passing into the capillaries, and modify- 
ing the condition of the circulating fluid, impresses their sensibilities 
differently ; so that a new action is often induced in them ; and the re- 
sult is favoured by the new impression made by the external application 
of an ointment, or a solution of iodine, to the parts affected. 

Iodine has likewise been given in several affections which it is diffi- 
cult to classify — as in the advanced stage of pneumonia, in inconti- 



308 SPECIAL EUTROPHICS. 

nence of urine, leucorrhcea, discharges from the nose, scorbutic states of 
the gums, mercurial salivation, stricture of the oesophagus, affections of 
^» the mucous membrane of the middle ear, sclerotitis, iritis, sclero-iritis, 
and corneitis, chronic inflammation of the lachrymal gland, impotence; 
— and as an efficacious remedy in checking or controlling the ulcerative 
process, — the most active phagedenic ulcers often yielding in a surpris- 
ing manner to its influence, and assuming a healthy, granulating appear- 
ance. 

Iodide of potassium, in large doses and long continued, has appeared 
to exhibit power over acute, and especially over chronic rheumatism ; 
and it has been ocasionally used with success in tophaceous and other 
articular enlargements occurring in gout : — but it is difficult to enume- 
rate the various heterogeneous cases in which iodine and its prepara- 
tions have been prescribed. (For details see New Remedies, 5th edit. 
p. 399, Philad. 1846.) 

As a local application, iodine is a useful- agent in many diseases. In 
cutaneous affections of various kinds, the tincture, applied pure or 
diluted — as the case may require — has been of eminent service, as in 
lupus, porrigo, impetigo, &c. ; and it has been advised in various dis- 
eases, to fulfil the same objects as nitrate of silver. For example, it 
has been painted over the part with a camel's hair pencil, dipped in the 
tincture, in erysipelas ; phlegmon ; sloughing of the cellular membrane 
after phlegmonous erysipelas; acute inflammation; anomalous pains; 
chronic inflammation and enlargement of the joints ; inflammation of 
the absorbents; anthrax; boils; buboes; malignant ulcers of the 
tongue and tonsils ; scrofulous swelling of the glands ; chilblains ; lace- 
rated, contused, and punctured wounds ; burns and scalds ; gouty and 
rheumatic swellings ; fistulous openings ; malignant or adventitious 
excrescences ; stings of wasps ; disease of the spine ; ununited frac- 
tures; orchitis; chronic ophthalmia ; opacities of the cornea; dissec- 
tion wounds ; as an ectrotic to variolous pustules to prevent pitting, &c. 
— in many of which affections it doubtless acts as an ordinary excitant ; 
and the same may be said of it as an injection in hydrocele, and other 
forms of dropsy, in which the tincture has been employed with consi- 
derable success in the proportion of one or two fluidrachms to a fluid- 
ounce of water. 

In regard to the different preparations of iodine, practitioners do not 
all accord as to which is deserving of the preference. The ioduretted 
iodide of potassium, in the form of Lugol's solution, has generally 
been selected ; but, of late, iodide of potassium has been more em- 
ployed perhaps. A modern writer, Dr. A. Buchanan, is inclined to 
place them in the order of therapeutical value as follows: — iodide of 
starch, hydriodic acid (iodine,) and iodide of potassium ; although he 
admits, that the superiority which he ascribes to the first is, perhaps, 
owing to his having prescribed it most frequently. The action of all 
is similar ; and the only mode, he thinks, of explaining such similarity 
of action of substances so dissimilar in nature, is by considering hy- 
driodic acid as the active principle, — free iodine being immediately 
converted in the stomach into hydriodic acid. 

It has been imagined by many, that when iodine disagrees, it is 



IODINUM. 309 

owing to free iodine acting on the stomach ; and hence the tincture 
has been regarded as an objectionable form ; but the same symptoms 
are said to have resulted from the use of the iodides. Dr. C. J. B. 
Williams, however, is disposed to ascribe them to free iodine existing 
in these preparations also ; to obviate which, it has been recommended, 
that the patient should take a piece of bread or biscuit after each dose, 
— the starch combining with the free iodine, and forming a harmless 
compound. It may be sufficient to direct, that they should not he)- 
taken on an empty stomach. Should morbid phenomena arise, that are 
referable to the remedy, it must, of course, be discontinued. 

Iodine is not readily given in substance, pill or powder. Its dose is 
about half a grain. Externally, it is applied in the form of tincture, 
ointment, or watery solution, or in baths or fumigations. Frictions with 
it readily occasion considerable irritation of the skin, which commonly 
soon passes away, when the friction is suspended for a while. After 
bathing a part of the cutaneous surface, painful rubefaction often ensues, 
which is usually followed by perspiration and sleep. Dr. Pereira says, 
that the most effectual method of employing iodine externally is the 
endermic, an ioduretted ointment being applied to the cutis vera after 
the epidermis has been removed by a blister. The plan is not, how- 
ever, much used. 

TINCTU'RA IOD'INI, TINCTURE OF IODINE. (Iodin. §j ; Alcohol, Oj.) It 
has been urged as an objection to this formula, that its strength is apt 
to vary ; that it deposits iodine in the crystalline form ; undergoes de- 
composition when exposed to solar light, — the iodine taking hydrogen 
from the alcohol and forming hydriodic acid, which acts on the spirit, 
and forms a little hydriodic ether; and moreover, that the free iodine 
is deposited when water is added, and may irritate the stomach; but 
the last objection is the least forcible of all, as such a result is, un- 
doubtedly, very rare. To obviate these objections, however, the next 
preparation has been introduced, — the simple tincture being chiefly %v. 
used as an external application. Sixteen minims of the tincture contain 
one grain of iodine, and the ordinary dose is ten to twenty drops gra- 
dually increased, three times a day, in sugared water, or in wine. The 
mode of employing it externally has been already mentioned. 

TINCTU'RA IOD'INI COMPOSITA, COMPOUND TINCTURE OF IODINE. (Iodin. 

^ss ; Potassii iodid. 5j ; Alcohol. Oj.) Iodide of potassium is added 
in this preparation to prevent the deposition of free iodine. The dose 
is ten to twenty drops, gradually increased. Dr. Todd has recom- 
mended an ' Iodine paint' composed of 64 grains of iodine and 30 grains 
of iodide of potassium in an ounce of alcohol, to be applied freely by 
means of a camel's hair brush, where effusion has taken place into 
synovial membranes or sheaths. 

UNGUEN'TUM IOD'INI, OINTMENT OF IODINE. [Iodin. gr. xx ; Alcohol. 
*lxx ; Adipis 5y) This ointment, when rubbed repeatedly on the skin, 
induces a pustular eruption. Should it be desirable to avoid this, its 
strength must be reduced by an additional quantity of lard. 



310 SPECIAL EUTROPHICS. 

UNGUEN'TUM IOD'INI COMPOS'ITUM, COMPOUND OINTMENT OF IODINE. (Iodin. 
3ss ; Potass, iodid. 3j ; Jllcohol. f.3j ; •fldipis gij.) Employed in the 
same cases as the last. 

20. POTAS'SII IOD'IDUM.— I'ODIDE OF POTAS'SIUM. 

Iodide or Ioduret of potassium, Hydriodate of potassa, according to 
the Pharmacopoeia of the United States, is made by mixing iodine with 
distilled water, and adding iron filings so as to form iodide of iron, 
which is decomposed by carbonate of potassa ; thus forming carbonate 
of iron by precipitation, and iodide of potassium in solution, which, by 
evaporation, yields crystals. 

Iodide of potassium, thus made, is in white or transparent crystals, 
which are wholly soluble in two-thirds of their weight of water at 60°. 
The solution dissolves iodine, forming ioduretted iodide of potassium. 
The iodide is likewise soluble in alcohol. It is exceedingly liable to 
adulteration both from faulty manufacture and fraud. Dr. Pereira 
states, that in 1829 he analyzed a sample, w 7 hich contained 77 per cent, 
of carbonate of potassa : Dr. Christison affirms, that he has seen speci- 
mens which contained only 9.5 per cent, of the pure salt; and it would 
appear, that at one time most of the iodide of potassium used in Great 
Britain was of this composition. In such case, it is said to be granular 
and deliquescent. (Christison.) Ten grains of the pure iodide in solu- 
tion decompose 10.24 grains of nitrate of silver. 

The medical properties of this salt are identical with those of iodine, 
than which it is now more frequently prescribed. It may be given in 
very large doses, without producing any unpleasant effects; yet occa- 
sionally it seems to act as an irritant, and therefore caution ought to be 
indulged, especially as it has been shown that the salt is very liable to 
adulteration. Dr. Buchanan affirms, that he has given it in the dose of 
§ss, and the only precaution he observed was to make the patient drink 
freely of diluents. He gave it in these large doses to determine some 
physiological questions in regard to its absorption. Two drachms were 
taken by a young man affected with gonorrhoea ; and as soon as the 
medicine made its appearance in the urine, blood was drawn from the 
arm. On examining the blood, both the serum and crassamentum were 
found deeply impregnated with iodine. It has been given internally 
in all the cases in which iodine has been prescribed ; and in large doses 
is a favourite preparation in syphilitic, syphiloid, and other cachexia? ; 
and in rheumatism. M. Lugol appears to have used it mainly as a sol- 
vent to iodine, and he considered it inferior to the latter as a therapeu- 
tical agent ; but no chemical or other prepossession can set aside the 
overwhelming testimony that has been adduced in its favour. The 
author has given it largely, and has certainly obtained from it all the 
advantages which the preparations of iodine are capable of affording. 
A case of salivation by it has been published. 

The ordinary dose is three grains, three times a day. The au- 
thor has not exceeded twenty grains for a dose; but it has been carried 
to a much greater extent. It is given in the state of solution, {Potass. 



PLUMBI IODIDUM. 



311 



iodid. 3j ; Jlqua destillat. f.sj. Dose, fifteen drops three times a day,) 
associated generally with the use of an ointment of iodine. Most fre- 
quently, however, iodine is added to it to form an ioduretted iodide, as 
in the 

LIQUOR IOD'INI COMPOS'ITUS, COMPOUND SOLUTION OF IODINE. (Iodin. 3vj ; 
Potass, iodid. §iss ; Jiqux destillat. Oj.) This solution, also called 
Compound solution of iodide of potassium and Solution of ioduretted 
iodide of potassium, is commonly used as LugoPs solution. The ordi- 
nary dose is ten or fifteen drops, three times a day, in sugared water ; 
but it may be carried much farther. Lugol himself had solutions of va- 
rious strengths, both for internal and external use. 

The formulae for Tinctura iodini composita, and Unguentum iodini 
compositum, which are ioduretted iodides of potassium, have been give 
before, (p. 309). 

21. FERRI IOD'IDUM.— I'ODIDE OF IRON. 

The general properties of iodide of iron have been described under 
the head of Tonics. (Vol. ii. p. 62.) It was then stated, that the salt 
is especially adapted for cases in which there appears to be torpor in 
the system of nutrition. It has been given in various cachexias — scro- 
fulous, cancerous, scorbutic, tubercular, and hydropic ; and has often 
proved highly serviceable. It appears to be one of the best remedies 
we possess, wherever a eutrophic and tonic agency is needed. 

The dose of LIQUOR FERRI IODIDI, (Vol. ii. p. 64,) as a eutrophic, is 
ten drops, three times a day, in sugared water, — gradually increasing 
the quantity. 

22. PLUMBI IOD'IDUM.— I'ODIDE OF LEAD. 

Iodide of lead is formed, according to the London Pharmacopoeia, by 
the double decomposition of iodide of potassium and acetate of lead. 
The precipitate formed is iodide of lead. It is of a bright yellow 
colour, devoid of taste and smell, and very sparingly soluble in cold 
water. It dissolves in boiling water, from which it mainly separates, 
as the solution cools, in the form of minute, shining, yellow, crystalline 
scales. 

Iodide of lead is not an irritant, even when applied to a denuded sur- 
face ; nor is it an active agent, when administered internally. It has 
been given in the dose of a quarter or half a grain in scrofulous affec- 
tions of the glands, joints, &c, made into a pill with confection of roses. 
Some have administered it in much larger quantities. Dr. Pereira gives 
the dose at three or four or more grains, — Dr. O'Shaughnessy says ten 
grains are readily borne, without the slightest annoyance ; and M. Bally 
has given 30 grains in a dose. It is applied externally, in the form of 
ointment, in the way of friction, in scrofulous and other indolent swell- 



312 SPECIAL EUTROPHICS. 

ings. UNGUENTUM PLUMBI IOD'IDI, {Plumb, iodid. Sj : Adipis gviij ;) i s 
officinal in the London Pharmacopoeia. 

Some other preparations of iodine are likwise used — 23, Iodide, and 
24, Red Iodide of Mercury, which have been already described, (p. 
300). 

25. Iodide of Arsenic has been frequently used in phagedenic tuber- 
culous herpes, in the form of ointment, (Arsenic, iodid. gr. iij ; Adipis 
^j.) It has been also given internally with success in lepra and impe- 
tigo, in the dose of one-tenth of a grain. It is a very poisonous sub- 
stance, and requires to be administered with caution. 

26. Iodide of Mercury and Arsenic, the mode of preparing which 
is given elsewhere, (see the author's New Remedies, 5th edit. p. 368, 
Philad., 1846,) has been prescribed largely as a eutrophic in chronic 
cutaneous diseases — as psoriasis, lepra, lupus, and in scrofulous and 
syphilitic affections. It has, likewise, been used externally in the same 
diseases. 

27. Iodide of Barium, administered in small doses, has been found 
serviceable in scrofulous and other cachexia?, in which chloride of ba- 
rium is indicated. M. Biett gave it in cases of scrofulous swellings, 
and applied it externally; — (Barii iodid. gr. iv ; Adipis ij.) 

28. Sesqui-iodide of Carbon has been used with advantage in cases 
of enlarged glands in the form of ointment, (Carbon, sesqui-iodid. Jss ; 
Cerat. 5vj ;) and also in lepra and porrigo. 

29. Iodides of Quinia and Cinchonia have been employed for the 
cure of scrofulous tumours, in cases where iodine and tonics are indi- 
cated. 

Iodide of quinia may be prepared, according to Dr. A. T. Thomson's 
formula, by triturating together in a mortar 164.55 grains of pure quinia, 
and 126.3 grains of iodine, — the latter being added to the former until 
the whole is intimately mixed ; and then boiling the mixture in a mode- 
rate quantity of distilled water at first, adding more by degrees, until 
as much is added as will give one grain of iodine for each fluidrachm 
of the solution. 

Iodide of quinia, in solution, is of a pale straw colour, limpid, evol- 
ving a faint odour of iodine, and impressing upon the palate the bitter 
of quinia. The real nature of the salt contained in the solution has not 
been determined by Dr. Thomson. 

30. Iodide of Ammonium was introdued into medical practice by M. 
Biett, as a valuable agent in chronic cutaneous diseases, and especially 

<v\s in lepra and psoriasis. It is used in the form of ointment : (Amnion, 
iodid. 9j — 3j; Adipis Ij.) As the ointment is readily decomposed, it 
ought to be freshly prepared, and be excluded from the air. 



BROMINUM. 



313 



31. Iodide of Starch is a favourite preparation with Dr. Buchanan, 
of Glasgow ; but it is rarely employed. The dose is 3ss, gradually 
increased. 

32. SUL'PHURIS IOD'IDUM, IODIDE OF SULPHUR, is officinal in the last 
edition of the Pharmacopoeia of the United States. It is formed by 
heating slightly a mixture of iodine and sulphur in certain proportions. 
It is a dark substance ; very deliquescent, and resembling, in appear- 
ance, sesquisulphuret of antimony. It is entirely dissipated by heat, 
and when boiled in water, iodine escapes with the vapour, and sulphur 
is deposited nearly pure. 

Iodide of sulphur is not given internally, but it forms an excellent appli- 
cation in many chronic cutaneous diseases. It has been found especially 
efficacious in psoriasis, applied in the form of friction. It has also beenf*^ 
used with success in lepra vulgaris, acne indurata, porrigo, lupus, herpes 
pustulosus, h. labialis, &c. The author has found it the best application in 
some cases of inveterate porrigo of the scalp ; and he regards it as an 
excellent local application in chronic cutaneous affections in general. 
The ointment may be made of Iodide of sulphur 9j — 3 SS > Lard or 
simple cerate 3j ; Oil of Bergamot gtt. x. 

The inhalation of the vapour of the iodide was employed by Dr. 
Copland in a case of humoral asthma, with temporary advantage. It 
has, likewise, been used as a fumigation in cases of atonic ulcers, and 
in chronic cutaneous affections. With this view, the sulphur and the 
iodine may be combined extemporaneously, — say, four parts of iodine to 
one part of sulphur. 

33. BRCMINUM —BROMINE. 

Bromine, Brominium y Bromineum, which was discovered in the year 
1826, and obtains its name from Bpw^, " a stench or smell," is greatly 
allied in its chemical properties to chlorine and iodine ; and in its 
medical virtues to the latter. It is met with chiefly in seawater, and in 
certain animal and vegetable substances that live therein. It has, like- 
wise, been found in many mineral waters of this and other countries, 
and especially in the salt springs— as of Salina, by Professor Silliman, 
and of Kenawha, by the author's late friend, Professor Emmet, of the 
University of Virginia. 

Bromine is in the secondary list of the Pharmacopoeia of the United 
States, (1842,) and may be obtained by various processes, which 
are given elsewhere, (New Remedies, 5th edit. p. 134; also Pereira.) 
In the bittern or mother liquor of sea-water, from which chloride of 
sodium has been separated by crystallization, bromine exists in the 
state of bromide of magnesium ; this is decomposed by passing a 
current of chlorine through the bittern, which unites with the mag- 
nesium. The bromine dissolves in ether, and the solution is treated 
with solution of potassa, by which bromide of potassium and bromate 
of potassa are formed. In the meantime, the ether becomes colourless 
and pure, and may be employed in dissolving fresh portions of bromine. 
When a sufficient quantity of the salt has been obtained, it is mixed in 



314 SPECIAL EUTROPHICS. 

a retort with black oxide of manganese, and slightly diluted sulphuric 
acid, which occasion the disengagement of bromine in reddish, very 
acrid vapours, that are condensed in an appropriate receiver by means 
of ice or snow. 

At the ordinary temperature, bromine is a fluid of a blackish red 
colour, when regarded in quantities; but of a hyacinth red, when 
placed in a thin layer between the eye and the light. Its smell is 
powerful and disagreeable, resembling that of chlorine, and its taste 
strong. It colours the skin yellow, — the colour gradually disappearing. 
Its specific gravity is 2.966. It dissolves in very small quantity in 
water ; in greater proportion in alcohol ; and in still greater in sul- 
phuric ether. 

Bromine — as already remarked — resembles iodine in its therapeutical 
relations ; and, like it, belongs to the class of irritant poisons. A recent 
writer, Dr. Glover, places it intermediate in physiological properties 
between chlorine and iodine, but more nearly related to the former 
'Vv than to the latter. In medicinal doses, it has been administered in the 
same cases as iodine. It is far lass frequently employed, however. It 
may be prescribed mixed with water, in the proportion of one part of 
bromine to forty parts of water. Of this, five or six drops may be given 
in syrup, three or four times a day, gradually increasing the dose. 

34. Potas'sii Bro'midum, Bromide of Potassium, Hydrobromate of 
Potassa, is an officinal preparation in the London Pharmacopoeia, and 
the mode of preparing it is an exact counterpart for that of preparing 
iodide of potassium. It may, likewise, be made by dissolving bromine 
in alcohol, and adding potassa, until the spirit begins to change colour; 
then evaporating, and heating to redness. , 

This salt crystallizes in cubes or rectangular four-sided tables, which 
are devoid of smell, and are of a pungent saline taste, similar to common 
salt, but more acrid. It is very soluble in both hot and cold water; 
slightly so in alcohol. The solution of bromide of potassium dissolves 
no more bromine than pure water, in which respect it does not resemble 
iodide of potassium. 

The effects of bromide of potassium on the economy appear to re- 
semble those of iodide of potassium. It has been used in goitre, 
scrofulous affections, enlarged spleen, chronic cutaneous diseases, &c, 
but is not much prescribed. Its dose is from four to ten grains three 
times a day. It may be given in sugared water. An ointment {Potass, 
bromid. 3ss — 3j '■> ^dipis ^j ;) has been rubbed on scrofulous swellings, 
and applied to cutaneous affections. M. Magendie adds bromine to it. 
(Potass, bromid. gr. xxiv; Bromin. gr. vj — xij ; Jidipis Ey) 

35. Bromide of Iron is made by heating equal parts of bromine and 
iron filings under water, filtering the fluid as soon as it becomes of a 
greenish colour, and evaporating to dryness. The reddish residue— 
again dissolved in water, and evaporated — is bromide of iron. It has 



OLEUM JECORIS ASELLI. 315 

a brick red colour ; dissolves readily in water ; is deliquescent in the 
air, and has a very styptic taste. 

It may be used in the same cases and doses as iodide of iron. 

36. Protobromide, and 37, Deutobromide of mercury resemble 
respectively, in their remedial powers, iodide and red iodide of mercury. 
They are very little used. The testimonials in their favour are referred 
to in another work, (New Remedies, edit. cit. p. 353.) 

38. SPON'GIA USTA.— BURNT SPONGE. 

Calcined or burnt sponge is prepared by taking a convenient quantity 
of ordinary sponge, cutting it into pieces, and beating it to separate ex- 
traneous matters from it ; burning it in a close iron vessel until it becomes 
black and friable ; and rubbing it into very fine powder. Preuss cal- 
cined 1000 parts of sponge : of these, 343.848 parts were destroyed by 
heat. The residue consisted of carbon and insoluble siliceous matters, 
327.0 ; chloride of sodium, 112.08; sulphate of lime, 16.430 ; iodide 
of sodium, 21.422 ; bromide of magnesium, 7.570; carbonate of lime, 
103.2; magnesia, 4.73; protoxide of iron, 28.720 ; and phosphate of 
lime, 35.0. If good, it ought to evolve the violet vapour of iodine, 
when heated in a flask with sulphuric acid. 

Since the discovery of iodine, burnt sponge has been almost laid 
aside as a medicinal agent. Its virtues are, doubtless, mainly dependent 
upon the iodine and bromine which it contains; yet a part may be owing 
to the animal charcoal, which — as shown elsewhere — has been found 
efficacious in similar cases ; and we can therefore understand, that burnt 
sponge may have occasionally proved serviceable after iodine had failed. 
It has been chiefly given in goitre, in scrofulous affections, and in 
chronic cutaneous diseases. Its dose is from one to three fluidrachms 
in syrup, molasses or honey. 

39. O'LEUM JECORIS ASEL'LL— CODLIVER OIL. 

Codliver oil— also called Oleum Morrhuse, Cod oil—is obtained, for 
commercial purposes, from several of the fishes belonging to the Genus 
Gadus ; Ord. Malacopterygii thoracici ; but especially from codfish, 
coalfish and burbot. Several varieties of the oil are met with in com- 
merce, which differ from each other by their lighter or darker hue, and 
their greater or less transparency. According to Riecke, the oil is ob- 
tained by exposing to the sun the livers of the fish above mentioned, 
cut in slices ; and collecting the oil that runs out. The first obtained is 
the yellow oil, Oleum jecoris aselli fiavum. If the livers are running 
gradually to putrefaction, the oil becomes of a chestnut brown colour— 
Oleum jecoris aselli subfusco-flavum ; and, lastly, after the oil has been 
obtained by these methods, some can still be procured by boiling the 
livers, which constitutes the dark brown— Oleum jecoris aselli fuscum. 
One of these only, according to Dr. Pereira, is to be met with in com- 
merce in London. It is, probably, the second variety ; and is used by 



316 SPECIAL EUTROPHICS. 

curriers for dressing leather. In Germany, the first variety seems to be 
most employed. It is now prepared in considerable quantity in 
Boston. 

On analysis, it has generally been found to contain iodine and bromine 
in small proportion. 

In Belgium, the oil of the liver of the ray — Raja pastinaca, R. cla- 
vata and R. batis, is preferred. It is said to contain more iodine, and 
to be less offensive than codliver oil. 

Codliver oil has long been a popular remedy in Germany, especially 
in Westphalia, — as well as in Holland, and, to a less extent, in England. 

It is of a repulsive taste, and often induces nausea ; yet patients may 
soon become accustomed to it ; and children often take it without re- 
pugnance. Where the stomach is readily disordered, it is rarely retained ; 
but its retention is facilitated, if a little claret be taken after it. The 
effect which it induces upon the system of nutrition, when cachexia 
exists, is similar to that of eutrophics in general. It, doubtless, furnishes 
a modified chyle, and of consequence, a modified blood : this induces 
a new action in the tissues, which it laves, — acting, in these respects, 
like sugar, both dietetically and therapeutically. It has been suggested 
by some, that its remedial powers are owing to the iodine which it con- 
tains ; but this is not believed by others ; and Mr. Donovan is of opinion, 
that every known fact impugns the notion. It is true, that in all the 
specimens examined by De Jongh, minute portions of iodine could be 
detected ; but they never exceeded .05 per cent. On the other hand, 
equally beneficial effects have resulted from oil that contained no iodine. 
Many years ago, the author stated to his clinical class, that such had 
been the result of his observation ; and that vegetable oils had appeared 
to him to exert an equal action. Testimony, too, has been afforded in 
favour of the good effects of other animal oils. " Of fish oils," — ob- 
serves Dr. C. J. B. Williams, in the last edition of his " Principles 
of Medicine" (1848) — " experience chiefly testifies in behalf of that 
from the liver of the cod ; but analogy favours the supposition, that 
spermaceti oil and seal oil, if equally purified, would be no less eligible, 
and they would have an obvious advantage in their more abundant 
supply, and lower price :" —and he adds in a note. " I think it scarcely 
necessary even to advert to a supposition formerly general and still 
entertained by a few, that cod-oil owes its efficiency either to its offen- 
sive impurities, or to any iodine which it contains. I will merely state, 
that in some hundreds of cases in which I have prescribed the oil, the 
best effects have generally resulted from the use of the purest kind; and 
in many of these cases various forms of iodine had been exhibited 
without producing any of those marked changes which followed the 
taking the oil." 

Under the views possessed by the author the least offensive form of 
oil ought to be selected. 

A recent report, (1849) of the Hospital for Consumption and Diseases 
of the Chest, by the physicians of the institution, is highly favourable to 
the use of this oil. Other animal oils not derived from the liver, and 
vegetable oils were tried. " The experiments hitherto made have not 



CARBO ANIMALIS. 317 

shown them to possess the same powers ; but they have not been as yet 
sufficiently often repeated to warrant decided conclusions." The effects 
on 542 cases are reported. From these it appears, that in about 63 per 
cent, the symptoms improved ; in 18 per cent, the disease was arrested ; 
and in 19 per cent, it went on unchecked. One of the most striking 
effects was an increase in the weight of the patient ; w r hich in some cases 
was astonishing. The oil now used in that hospital is straw-coloured, 
transparent and free from offensive smell. 

Cod liver oil has been brought forward with high encomiums in 
scrofula, rickets, and in every form of chronic rheumatism, tuber- 
culous cachexia, chronic cutaneous diseases, wherever, indeed, a 
modification is required in the system of nutrition generally or locally. 
It has likewise been used externally in opacities of the cornea — a 
drop or two being placed on the cornea with a camel's hair pencil ; and 
in various chronic cutaneous diseases. In some troublesome affections 
of the skin, especially of the hands, conjoining the characters of impe- 
tigo with erysipelatous redness and swelling, and inducing severe suf- 
fering, Dr. Marshall Hall speedily succeeded in restoring the textures to 
a healthy condition by its external use, after other remedies had been 
tried fruitlessly. For rhagades and chaps, he says, it is a preventive 1 ^ 
and a speedy cure ; and it is productive of great benefit in eczema, 
and other affections accompanied by excoriation and fissures of the 
skin. 

The dose is from half a tea-spoonful to three spoonfuls two or three 
times a day. To children it is given by tea-spoonfuls. Its unpleasant 
taste can scarcely be corrected by admixture with other agents ; for 
which reason it is preferred by some to give it in its pure state, and to 
take peppermint lozenges afterwards. It is also recommended that it 
should be given with coffee, lemon-juice, warm table beer, or in emul- 
sion. The taste may be disguised by chewing a piece of dried orange 
peel immediately before and after swallowing it. 

40. CARBO ANIMA'LIS.— AN'IMAL CHARCOAL. 

Animal charcoal may be prepared from any animal substance ; but, 
as directed in the Pharmacopoeia of the United States, it is obtained 
from bones, and constitutes Ivory black of commerce. This is, however, 
in an impure state, and accordingly, a process for CARBO ANIMA'LIS PURI- 
FICA'TUS is contained in the Pharmacopoeia of the United States, which 
consists in pouring muriatic acid, previously mixed with water, gradu- 
ally upon charcoal, and digesting with a gentle heat for two days, occa- 
sionally stirring the mixture. The charcoal, which subsides, is washed 
frequently with water, until it is entirely freed from acid ; and is then 
dried. 

Animal charcoal is an ancient remedy, which Dr. Christison errone- 
ously affirms to be now entirely abandoned. It is, indeed, much used 
in Germany, at the present day, as a eutrophic in scrofulous and can- 
cerous affections ; and like burnt sponge — although it contains no 
iodine — has been employed with success in goitre. It has been sug- 



318 SPECIAL EUTROPHICS. 

gested, that farther trials might show, that it may be used in the place 
of iodine ; but it is doubtful, whether the properties of the two sub- 
stances can be regarded as at all analogous ; and whether animal char- 
coal be possessed of any other properties than those usually ascribed to 
charcoal. It is given in doses of from half a grain to three grains two 
or three times a day, mixed with sugar or liquorice powder. It has 
also, been sprinkled on the callous edges of cancerous ulcers ; and has 
been used in the form of ointment, as a discutient, in scrofulous swell- 
ings. It is employed in many processes of pharmacy as a decolorising 
agent. 

41. CAL'CII CHLO'RIDUM.— CHLORIDE OF CAL'CIUM. 



Chloride of calcium , Hydrochlorafe or Muriate of lime, which — as its 
name imports — is a compound of chlorine and calcium, is made by 
saturating muriatic or chlorohydric acid with carbonate of lime; drying 
the salt ; exposing it to heat, and keeping it in well stopped vessels. 
It is not in the list of preparations, but in that of the Materia Medica 
of the Pharmacopoeia of the United States. It exists in sea water, and 
in many mineral springs ; in some of which it is considered to consti- 
tute the active ingredient, as in the springs of Airthrey, Pitcaithley, 
and Dumblane in Perthshire, Scotland. (Christison.) It is also ob- 
tained from the residuum of certain officinal preparations — as from the 
manufacture of carbonate of ammonia, solution of ammonia and spirit 
of ammonia; from which, indeed, it is usually procured by the manu- 
facturing chemist. 

It is colourless ; slightly translucent ; solid ; hard ; friable ; deliques- 
cent ; and wholly soluble in water. Its taste is bitter, acrid and saline. 

In large doses, it appears to be an irritant poison ; but in small doses, 
it has been administered, and with advantage, as a eutrophic, in scro- 
fulous cases. With this view, it must be continued for some time. It 
has been considered as one of the most important ingredients in many 
mineral waters, that have seemed to be beneficial as alteratives. It is 
generally given in the form of 

LIQUOR CAL'CII CHLO'RIDI, SOLUTION OF CHLORIDE OF CAL'CIUM, Solution of 
Muriate of lime. {Marmor. in frustul. §ix ; Acid muriat. Oj ; Aq. 
destillat. q. s. The acid is mixed with half a pint of water, and the 
marble gradually added; chloride of calcium is formed in the manner 
previously mentioned, which is dissolved in its weight and a half of 
distilled water, and the solution is filtered.) The dose is from f.Jss to 
f.Jj gradually increased. It may be taken in sugared water or milk. 

It is sometimes also used as a wash to scrofulous sores and chronic 
cutaneous affections. {Calcii chlorid. 5j— -Jij ; Aquae destillat. fjviij ;) 
and, also, in the form of ointment, {Calcii chlorid. 3j ; Adipis 5j ;) in 
similar cases. 



ARSENICI PRiEPARATA. 



319 



42. BA'RII CHLO'RIDUM.— CHLORIDE OF BA'RIUM. 

Chloride of barium, Muriate of baryta, Baryta marias, is made by 
gradually adding carbonate of baryta to dilute muriatic acid, to sa- 
turation ; filtering the solution, and evaporating, so as to form crystals, 
which are right rhombic plates or tables; sometimes double eight-sided 
pyramids. Its density is 2.82; taste disagreeable and bitter. It is 
wholly soluble in water— 100 parts at 60° dissolving 43.5 of the crys- 
tallized salt ; at 222°, 78 parts. It is slightly soluble in alcohol of the 
pharmacopcEia ; but is said to be insoluble in pure alcohol. 

In large doses, the chloride acts like acro-narcotic poisons, and may 
induce death. In small medicinal doses, its effects appear to be analo- 
gous to those of chloride of calcium, and it has been given in the same 
cases. It has been chiefly prescribed in scrofula ; but, at times, in other 
dyscrasies; and in chronic cutaneous diseases, bronchocele, &c. It 
has been used as a topical application in chronic cutaneous affections ; 
as a collyrium in strumous ophthalmia, and in opacities of the cornea; 
and as an ointment {Barii chlorid. gr. iv ; Jidipis Sj) it has been ap- 
plied to strumous sores, and to chronic cutaneous affections. It is 
usually administered in the form of 

LIQUOR BA'RII CHLO'RIDI, SOLUTION OF CHLORIDE OF BARIUM, Solution of 
Muriate of Baryta. {Barii chlorid. 3j ; Jiquce destillat. f.^iij.) The 
dose of this is five drops three times a day, gradually increased till it 
induces nausea or vertigo ; when it should be diminished. It is much 
employed in pharmacy as a test for sulphuric acid and sulphates.. 

ARSEN'lCI PRiEPARA'TA. — PREPARATIONS OF ARSENIC. 

The various preparations of arsenic are possessed of eutrophic vir- 
tues, and when continued for a proper length of time they so alter the 
function of nutrition as to remove diseased actions, which may have 
been persisting unmodified by other agents. In chronic cutaneous dis- 
eases, — for example, lepra, psoriasis, impetigo, &c, arsenic has been 
found a most valuable agent ; and often the beneficial results have 
occurred without any other manifest effects having been produced by 
the remedy. In all cases, however, the results should be watched; 
and if any of the phenomena that have been, referred to elsewhere, 
(Vol. ii. p. 87,) and that are fairly ascribable to the administration of 
arsenic be observed, it must be discontinued, or the dose be diminished, 
as the case may seem to require. This, indeed, applies to all cases in 
which arsenic is given as a eutrophic ; inasmuch as — like every other 
remedy belonging to the class — a protracted use of it is necessary to 
break in upon the vice in the system of nutrition. It is as a eutrophic, 
too, that arsenic has been recommended in syphilis, syphiloid and rheu- 
matic affections ; and in cancer, in which it would seem to have occa- 
sionally rendered service. 



320 SPECIAL EUTROPHICS. 



43. AC'IDUM ARSENIO'SUM.— ARSE'NIOUS ACID. 

Arsenious acid — whose properties have been detailed elsewhere, 
(Vol. ii. p. 86,) — is the form in which arsenic is generally administered 
in the above mentioned diseases. It may be given in the dose of one- 
tenth to one-eighth of a grain, made into a pill with crumb of bread ; 
or LIQUOR POTASM ARSENi'TIS (Vol. ii. p. 87,) may be given in the dose 
of eight or ten drops two or three times a day. 

Pilulce Asiatics, Asiatic pills are made of Arsenious acid, gr. lv ; 
Black pepper powder 3ix ; Gum arabic, sufficient to make 800 pills, 
each of which contains about one-twelfth of a grain of arsenious acid. 
They are much employed in India in cases of syphilis, elephantiasis, 
and other cutaneous diseases. 

44. AMMCNLffi ARSE'NIAS.— ARSE'NIATE OF AMMCNIA. 

This preparation is made by taking arsenic acid one part, dissolving 
it in water, and adding pure or carbonated ammonia sufficient to satu- 
rate it ; — or, as follows : — take of arsenious acid, one part ; nitric acid, 
four parts ; muriatic acid, half a part, — saturate the solution with car- 
bonate of ammonia, and let the arsenical salt crystallize. This salt 
has been employed in several obstinate cutaneous diseases, and espe- 
cially in psoriasis inveterata. One grain maybe dissolved in a fluid- 
ounce of distilled water ; and 20 to 25 drops of the solution be begun 
with daily ; gradually increasing the dose, until it reaches a drachm or 
more in the twenty-four hours. 

Arseniate of soda — in solution termed Aqua arsenicalis Pearsonii, 
and, by the French, Solution de Pearson — is possessed of the same pro- 
perties as arseniate of ammonia. 

Of the virtues of Iodide of Arsenic, and Iodide of Mercury and 
Arsenic, the author has already treated, (Vol. ii. p. 312). 

45. FERRI ARSE'NIAS.— ARSE'NIATE OF IRON. 

Arseniate of iron— which occurs naturally as scorodite, and is pre- 
pared artificially by double decomposition, according to a process given 
elsewhere— (New Remedies, 5th edit. p. 286, Philad. 1846,) has been 
recommended both as an internal and external remedy in cancerous 
W. formations. Its external application has been given already, (Vol. ii. 
p. 275). It has been prescribed internally in the form of pill, (Ferri 
arseniat. gr. iij ; Extract, gentian. 3iss ; Syrup, vel Aquae q. s. ut fiat 
massa in pilulas xlviij dividenda. Dose, one three times a day.) 

46. QUI'NI^ AR'SENIS.— ARSENITE OF QUINIA.; 

Arsenite of quinia has been lately recommended by Dr. Kingdon 
as a eutrophic, in chronic cutaneous affections especially. It is formed 
by dissolving arsenious acid and subcarbonate of potassa in distilled 
water, boiling and adding sulphate of quinia, previously dissolved in 
boiling distilled water. The precipitate is arsenite of quinia, which is 



AURUM METALLICUM. 321 

washed and dried on a filter. It is uncrystallizable ; and insoluble in 
water, but soluble in alcohol. 

The dose is one-third of a grain twice a day, gradually increased to 
three or four times a day, in the form of pill, or powder, mixed with a 
little sugar or gum. 

47. AURI PR^EPARA'T A. —PREPARATIONS OF GOLD. 

The preparations of gold have long been used in medicine ; but they 
had been wholly abandoned, when they were revived upwards of thirty 
years ago by M. Chrestien ; since which time they have been much 
employed ; and certain of them are received into the pharmacopoeias 
of Continental Europe. They all agree in their action on the economy. 

These preparations are corrosive in large doses ; but in medicinal 
doses, they have exhibited valuable eutrophic virtues. The secretions 
appear to be increased ; and occasionally actual salivation ensues, 
which differs from that induced by mercury, — being always slow in ap- 
pearing, and by no means so exhausting ; nor do troublesome ulcera- 
tions occur : the saliva is thinner, and not so tenacious : an aural fever, 
like the mercurial, can also be caused by them. 

Possessed of these properties, it is not surprising, that the prepara- 
tions of gold should have been prescribed in the same diseases as mer- 
cury. The testimony of many observers is recorded in their favour in 
syphilis. It would seem, that their action is slow. In some forms of 
scrofula, too, — as strumous ophthalmia, and strumous porrigo, — they 
would seem to have been efficacious. Experiments, however, have 
been discordant, even in regard to the activity of some of the prepara- 
tions, — the chloride or muriate of gold having been given in large doses 
by MM. Baudelocque and Velpeau, without inducing any irritant 
effects. They have, likewise, been prescribed in scirrhous and can- 
cerous affections, rubbed upon the gums ; or in cancer of the uterus, 
rubbed on the labia pudendi. In every form of cachexia, they have 
been given ; but they are not much used now T ; and one weighty objec- 
tion to them — in the absence of any decided superiority over other 
agents — is, that they are very expensive. 

48. AURUM METAL'LICUM.— METAL'LIC GOLD, 

has been given largely, and, according to some, successfully; but in 
the opinion of others, it has no action on the economy. It would be 
strange, indeed, if a substance, so difficult of oxidation, should have 
any effect. It has been prescribed in the dose of from a quarter of a 
grain to a grain. Gold powder — Pulvis auri — may be obtained by amal- 
gamating gold and quicksilver ; and driving off' the latter by heat. It 
may also be prepared by throwing it down from a dilute solution in 
nitro-muriatic acid by means of green sulphate of iron. From one to 
three grains, mixed with powdered starch, have been rubbed on the 
tongue. 
Vol. II.— 21 



322 SPECIAL EUTROPHICS. 



49. AURI CHLOOUDUM.— CHLORIDE OF GOLD. 

This preparation, called also Muriate of gold and Terchloride of 
gold, is received into several of the European pharmacopoeias. It is 
made by digesting one part of gold leaf in three parts of nitro-muri- 
atic acid, in a sand bath, and evaporating gently to dryness. 

It is one of the most active salts of gold, greatly resembling corro- 
sive chloride of mercury in its operation on the economy. Even a 
tenth of a grain, according to M. Orfila, has induced unpleasant gastric 
irritation ; yet, we have seen, it has been given to a much greater extent 
without inconvenience. It has been prescribed both internally and ex- 
ternally, in syphilitic, hydropic, strumous and other cachexias. Its dose 
is from one-sixteenth to one-twelfth of a grain, gradually but slowly 
increased ; or it may be rubbed on the gums. It has also been applied 
externally in the form of ointment, (Auri chlorid. gr. iv : Adipis £j ;) 
or as a collyrium in scrofulous ophthalmia, {Auri chlorid. gr. ij ; Aquce 

50. AURI ET SO'DII CHLO'RIDUM.— CHLORIDE OF GOLD AND SO'DIUM. 

This salt — called also Muriate of gold and sodium, and Auro-terchlo- 
ride of sodium — is likewise in some of the pharmacopoeias of Conti- 
nental Europe. It may be prepared by dissolving four parts of gold in 
aqua regia, and evaporating the solution to dryness; adding thirty-two 
parts of water, and one part of chloride of sodium, and evaporating to 
one-half. On cooling, crystals form. It is milder than the last prepa- 
ration ; but may be employed in similar cases, doses, and modes of 
administration. 

51. AURI CYANURE'TUM.— CYAN'URET OF GOLD. 

Cyanuret, Cyanide, or Tercyanide of gold may be prepared by care- 
fully adding a solution of cyanuret of 'potassium to one of chloride of 
gold, until a precipitate — cyanuret of gold— ceases to fall. It has been 
given in powder, mixed with gum arabic powder or sugar, in the dose 
of from one-sixteenth to one-tenth of a grain and more ; or rubbed on 
the gums, associated with orris powder, in syphilis and scrofula. It 
may, likewise, be prescribed in solution. {Jluri cyanuret. gr. iij ; 
Aquae f.^viiss ; Alcohol, f.^ss.) Dose, a tea-spoonful twice a day; 
gradually increased. 

52. AURI IOD'IDUM.— FODIDE OF GOLD. 

Iodide of gold is directed, in the French Codex, to be made by add- 
ing a solution of pure iodide of potassium to a solution of chloride of 
gold. The iodide of gold, which is precipitated, is collected on a filter 
and washed with alcohol to remove the excess of iodine precipitated 
with it. It has been used in the same cases as the other active prepa- 
rations of gold, in the dose of from one-fifteenth to one-tenth of a grain. 



ARGENTI PILEPARATA. 323 

It may also be made into an ointment, and be applied to syphilitic 
ulcers. 

53. AURI OX'IDUM.— OXIDE OF GOLD. 

Oxide, Teroxide or Peroxide of gold, Auric acid, is directed in the 
French Codex to be prepared by boiling four parts of calcined magnesia 
with one part of terchloride of gold, and forty parts of distilled water. 
The oxide is then washed, first with water to remove the chloride of 
magnesium, and afterwards with dilute nitric acid to dissolve the 
excess of magnesia. It has been administered in the dose of from 
one-tenth of a grain to a grain in the same cases as the other prepara- 
tions of gold. 



These are the chief preparations of gold that have been employed 
in medicine. For a more detailed account of their reputed virtues, 
see the author's New Remedies, edit. cit. p. 113. 

54. ARGEN'TI PR^PARA'TA.— PREPARATIONS OF SILVER. 

Various preparations of silver have been introduced into practice as 
eutrophics in the same diseases as the preparations of gold, and espe- 
cially in syphilis. M. Serre, Professor of Surgical Clinics at Montpellier, 
employed the chloride, cyanuret, and iodide ; divided metallic silver ; the 
oxide, and the chloride of ammonia and silver. At first, these were 
administered iatraleptically ; the chloride, the cyanuret, and the iodide 
in the quantity of one-twelfth of a grain ; the chloride of silver and 
ammonia in the quantity of one-fourteenth of a grain ; and the oxide of 
silver, and divided silver in the dose of one-eighth and one-quarter of 
a grain. These doses were often found, however, to be too small; he, 
therefore, raised those of the chloride and the iodide to one-tenth and 
one-eighth of a grain. The other preparations were augmented in the 
same proportion, with the exception of the chloride of silver and am- 
monia, which required more precautions than any of the others. M. 
Serre gave them internally, also. 

The results of the observations of others have not confirmed those of 
M. Serre. M. Ricord employed the various preparations, made accord- 
ing to the formulae of M. Serre, in the same doses ; but not being able 
to observe any effect that could be fairly ascribed to them, he ventured 
upon considerably large doses, — as much, for example, as twelve grains 
a day of the iodide and cyanuret, — but without any marked results. 

In this country, the preparations of silver have been but little used 
in syphilis, nor do they appear to merit special attention. For the 
testimony adduced in their favour, and the mode of preparing and 
exhibiting them, see the author's New Remedies, 5th edit. p. 78. 



55. The Preparations of Platinum, it is affirmed, possess properties 
analogous to those of gold and silver. 



324 SPECIAL EUTROPHICS. 



56. FERRI PR^EPARA'TA.— PREPARATIONS OF IRON. 

The various preparations of iron are employed occasionally in can- 
cerous and other cachexia?, as well as in lupus, and chronic cutaneous 
diseases; but subcarbonate of iron, (Vol. ii. p. 55,) is calculated to 
answer all the purposes of the other chalybeates. It has been pre- 
scribed, in very large doses, and often with excellent effect, in enlarge- 
ments of the spleen, that accompany or succeed intermittents. It may 
be given in dose of from gr. x to 5j and more, three times a day. 

57. ALKA'LIA.— AL'KALIES. 

Alkalies have been long employed under the idea that they rendered 
the blood thinner, and might soften obstructions, and remove tumours ; 
hence they have been freely exhibited in all hypertrophied conditions 
of the glandular organs ; but they are not much relied upon at the pre- 
sent day, although they doubtless have considerable power in modify- 
ing the condition of the circulating fluid, and consequently, that of the 
tissues bathed by it. In various cachexia? — the syphilitic and the 
strumous especially — they are considered by many to have proved 
extremely serviceable. Like mercurials, too, when given in diph- 
theritic inflammations, or those that are apt to end in the exudation 
of an albuminoid secretion, they are presumed to exert a liquefacient 
action on the blood. Hence, they have been administered in croup, 
and in diphtheritis in general. 

Under similar views in regard to their powers as eutrophics, they 
have been prescribed in chronic cutaneous diseases ; and wherever it 
has been desirable to excite a new action in the system of nutrition, 
generally or partially. 

Any of the alkalies may be given ; but Liquor PoTASsiE is most 
frequently chosen. It may be prescribed in the dose of ten drops, 
gradually increased to f-5j or more. 

58. AC'IDA MINERA'LIA.— MIN'ERAL ACIDS. 

Nitric Acid, (Vol. ii. p. 73,) does not perhaps possess any proper- 
ties which especially adapt it as a eutrophic ; yet it is the acid which, 
by common consent, appears to be selected. It has been extensively 
used in syphilitic cachexia as a substitute for mercury ; and has un- 
questionably been of service, especially where mercury has not agreed. 
It may not, however, have exerted any energetic action on the disease; 
for it is now admitted, that syphilis can, in the generality of cases, be 
cured without the use of mercury. Much reliance is not now placed in it, 
however, although it is still occasionally prescribed. It has, likewise, 
been given internally, especially in India, in chronic liver disease; 
but it is not clear, that its beneficial agency in such cases may not be 
owing to its tonic influence on the stomach. It is not unfrequently 
used as a tonic in chronic disease, and in convalescence from acute 
diseases, either alone or associated with bitter infusions. The dose of 



CHLORINUM. 325 

the diluted acid of the Pharmacopoeia of the United States is from gtt. xx 
to gtt. xl, three times a day. 

An ointment of nitric acid, (Vol. ii. p. 255,) is used in various chro- 
nic cutaneous diseases, especially in porrigo and scabies, and as an ap- 
plication to syphilitic sores. 

AC'IDUM NITRO-MURIAT'ICUM, NITRO-MURIAT'IC ACID. (Acid, nitric. f.§iv; 
Acid. Muriat. f.^viij.) This acid has been introduced into the last 
edition of the Pharmacopoeia of the United States. It is also termed 
Nitre-hydrochloric acid, and Aqua regia. It has been used as a eutro- 
phic in the same cases as nitric acid, and is employed also externally in 
syphilis and chronic liver affections. It is applied in the form of pedi* 
luvia, — the legs, thighs, and body being, at the same time, sponged 
with it. A fluidounce and a half of the acid may be added to a gallon 
of water, and the patient may keep his feet in the bath for twenty or thirty 
minutes. It produces more or less pricking of the surface, and is said 
at times to cause soreness of the mouth and increased flow of saliva. 
The effects of the bath have been ascribed to the chlorine evolved. 

The dose of nitro-muriatic acid, in the above mentioned cases, may be 
ten or fifteen drops diluted with water, two or three times a day. 

59. CHLCRINUM, or CHLORIN'IUM.— CHLORINE. 

Chlorine is most commonly prepared by mixing intimately three parts 
of dried chloride of sodium with one part of oxide of manganese ; and 
then, in a retort, adding as much sulphuric acid, previously mixed with 
its own weight of water, as will form a mixture of the consistence of 
cream. By applying a gentle heat, chlorine gas is copiously evolved, 
and may be collected over water. In this process, the chloride of sodium 
is decomposed and the oxide of manganese parts with a portion of its 
oxygen to convert the sodium into soda ; with which, as well as with the 
oxide of manganese, the sulphuric acid unites, and the chlorine is set free 
in the form of gas. 

Chlorine gas is of a greenish-yellow colour, of a peculiar strong, dis- 
agreeable, stifling odour ; and is irrespirable, except when very largely 
diluted with air. Of its effects when inhaled, mention has been made 
under Expectorants, (Vol. i. p. 257). 

Fumigations of this gas were particularly recommended, about twenty 
years ago, by Dr. Wallace, of Dublin. They would seem to resemble, 
in their action, the nitric and nitro-muriatic acid baths ; the latter of 
which has been supposed to owe its efficacy to chlorine. It has been 
used advantageously in chronic liver diseases, especially where there is 
disordered secretion of the liver ; and in many other morbid conditions, 
as hypochondriasis, cachexia?, and in all affections in which a prolonged 
excitation of the skin, and a restoration of its suppressed or impaired 
functions could be esteemed serviceable ; — hence in old cases of syphi- 
lis, scrofula, chronic rheumatism, chronic cutaneous affections, — as 
lepra, psoriasis and scabies, — and in many of these it has been highly 
beneficial. 



326 SPECIAL EUTROPHICS. 

Aqua Chlo'rini, Solution of chlorine, Liquid oxy muriatic acid, is 
contained in many pharmacopoeias. It is in those of Edinburgh and 
Dublin. In the former it is directed to be prepared as follows : — Take of 
chloride of sodium, gr. 60 ; sulphuric acid, (commercial,) f.3'ij ; red oxide 
of lead, gr. 350 ; water f.^viij. Triturate the chloride of sodium and 
oxide together ; put them into the water contained in a bottle with a 
glass stopper ; add the acid ; and agitate occasionally till the red oxide 
becomes almost white. Allow the insoluble matter to subside before 
using the liquid. 

Chlorine water has been occasionally given internally in chronic dis- 
eases of the liver; in many chronic cutaneous affections; and in various 
cachexia?, especially the syphilitic and strumous. In a dilute state, it 
has been used as a wash in skin complaints, and in atonic and malignant 
ulcers, — partly, however, with the view of correcting the foetor ; in which 
cases, as will be seen hereafter, it often serves a highly useful purpose ; 
with this object, however, some of the chlorinated preparations are most 
frequently employed. It has been used, also, like nitro-muriatic acid, 
as a bath in hepatic and syphilitic diseases. 

It is very liable to be decomposed ; and therefore ought never to be 
prescribed in quantity larger than is needed for twenty-four hours, as, 
by frequently opening the vial in which it is contained, decomposition 
readily ensues. The vial should be put into a dark place, and be sur- 
rounded by black paper. 

The dose of Aqua Chlorini of the British pharmacopoeias is f.Jss to 
f.^ss. An ointment is sometimes prepared of it; (Aquas chlorin. p.j ; 
Adipis p. vij ;) which is used in scabies. It is made, also, into a lini- 
ment, (Aq. chlorin. 3j ; 01. oliv. 3J ;) which is used in scabies, porrigo 
and herpes; and, at times, is prescribed as a gargle in ulceration and 
chronic inflammation of the mouth and fauces. 



60. CALX CHLORINA'TA.— CHLORINATED LIME. 

Chlorinated lime, Chloride of lime, Hypochlorite, Chlorite or Oxymu- 
Hate of lime, bleaching powder, is a compound resulting from the action 
of chlorine on hydrate of lime. It is prepared on a very large scale for 
the use of bleachers; and, therefore, is amongst the list of articles of 
the materia medica in the Pharmacopoeia of the United States. The 
London College has a form for its preparation, which consists in passing 
the vapour of chlorine into lime, until it is saturated. The chlorine is 
disengaged by the action of chlorohydric acid on oxide of manganese. 

The nature and composition of this chemical is a subject of dispute ; 
and hence the term chlorinated lime, which has been adopted by the 
London, Edinburgh, and United States Pharmacopoeias, in place of 
chloride of lime. It is of a grayish white appearance; pulverulent; 
dry, or but slightly moist ; and wholly dissolved by chlorohydric acid 
with the disengagement of chlorine. It is often of very inferior quality, 
either owing to the lime having been insufficiently charged with chlo- 
rine, or to its having been exposed to the air, so that chloride of cal- 
cium and carbonate of lime result. 



LIQUOR SODiE CHLORINATE. 327 

Chlorinated lime — like chlorine, on which its virtues are really de- 
pendent — has been administered in scrofulous cachexia, and especially 
in scrofulous swellings ; it is rarely, however, given internally as a 
eutrophic. Externally, it is applied in many cases, — in torpid ulcers 
of various kinds — the phagedenic, scrofulous, syphilitic, cancerous, 
gangrenous, &c, in which it acts as an excitant or antiseptic. It is em- 
ployed, also, in strumous swellings of the glands, joints, &c, in goitre, 
and in various chronic diseases of the skin. Dr. Christison affirms, that 
he never uses any other remedy in itch. " A solution, containing be- 
tween a fortieth and sixtieth part of chlorinated lime, applied five or 
six times a day, or continuously with wet cloths, allays the itching in the 
course of twenty-four hours, and generally accomplishes a cure in eight 
days." 

When given internally, the dose may be gr. j to gr. iv, two or three 
times a day, in pill or solution. When applied externally, it may be 
dissolved in water in various proportions, (f.^j to f.^ss, to f.^viij of 
water.) In cases of itch, the strength has sometimes been — chlorinated 
lime 5iij , water Oj. In the form of ointment, {Calcis Chlorinat. Jj ; 
Adipis §j,) it has been rubbed on scrofulous swellings, goitre, &c, and 
has been occasionally applied as a cataplasm, {Calcis chlorin. ; Sodii 
chlorid. aa 3ss ; Aqute destillat. Oss ; Farince sem. lin. q. s. ;) to scro- 
fulous tumefactions of the joints. 

Chlorinated lime enters into the formation of the next preparation. 



61. LIQUOR SOD^S CHLORINA'T^.— SOLUTION OF CHLO'RINATED SODA. 



This preparation, called also Hypochlorite of soda, Labarraque's Soda 
disinfecting liquor, Oxymuriate of soda, is made by dissolving carbo- 
nate of soda and chlorinated lime separately in water ; setting the latter 
aside until the dregs subside : then decanting the liquor, and mixing 
the two solutions ; again decanting the clear liquor from the precipi- 
tated carbonate of lime by passing it through a linen cloth, and keeping 
it in bottles secluded from the light. 

The solution — thus prepared, according to the directions of the Phar- 
macopoeia of the United States — is a colourless liquid, having a slight 
odour of chlorine. Its taste is astringent; and like chlorine, and all the 
chlorinated preparations, it destroys vegetable colours. In regard to its 
chemical constitution, the same remarks are applicable as were made on 
chlorinated lime. 

In its therapeutical properties, chlorinated soda resembles chlorinated 
lime, and has been prescribed, internally and externally, in the same 
cases. It is preferred, however, for internal, whilst chlorinated lime is 
generally chosen for external, use. 

The dose is from ten drops to a fluidrachm in plain or sugared water. 
When used externally, it is generally diluted with from five to ten parts 
of water, as an application to chronic cutaneous diseases, ulcers of va- 
rious kinds, burns, &c. 



328 SPECIAL EUTROPHICS. 



62. SULPHUR. 

The general properties of sulphur have been described before, (Vol. 
i. p. 162). As a eutrophic, it is mainly used in chronic cutaneous dis- 
eases, and especially in scabies, in which it is employed internally and 
externally. Associated with guaiacum, it is sometimes prescribed in 
gout and acute rheumatism, (see Vol. i. p. 321,) in which it is presumed 
to act as an excitant diaphoretic. Dr. Pereira states, that after an attack 
of acute rheumatism, when the joints were left in a swollen and painful 
state, he saw sulphur prove highly useful ; but this was only in one 
case. The popular form in which it is taken, mixed with ardent spirit, 
would adapt it rather — if it be adapted at all — for the chronic form of 
those diseases. It certainly passes through the cutaneous capillaries, 
and is disengaged from them, as is evidenced by a silver watch becom- 
ing blackened, when sulphur or a sulphuret is taken : but the quantity 
passing through a particular portion of the capillaries, at any one time, 
must be exceedingly minute ; and incapable, perhaps, of exerting much 
medicinal agency on cutaneous or other local affections. Hence, the 
external use is always, in such cases, combined with the internal. 

Under chlorinated lime, (Vol. ii. p. 327,) it was Stated, that Dr. 
Christison had found it an adequate substitute for sulphur in scabies ; 
but, on the whole, sulphur is the most certain application. It is, how- 
ever, so offensive, and its odour is generally considered to reveal so 
completely the nature of the disease for which it is used, that every 
endeavour has been made to discover some agent that may be equally 
sure, and less objectionable. The discovery of the itch insect — Jlcarus 
scabiei — led to the supposition, that the modus operandi of sulphur, 
in the cure of scabies, may consist in its destroying the parasite. The 
precise connexion, however, of the insect with the itch, is not yet 
clearly ascertained ; and, moreover, sulphur — as already remarked — has 
been found efficacious in other chronic cutaneous diseases. 

Sulphur has long been regarded by the people as a great eutrophic or 
purifier of the blood, and even at this day it is a popular remedy, with 
this view, at spring and fall. Either SULPHUR or SULPHUR PRMPITATUM 
(Vol. i. p. 162,) may be prescribed in the dose of gss to 3J, and more, 
in milk ; or it may be mixed with an equal quantity of molasses, and a 
tea-spoonful be taken night and morning. Bitartrate of potassa is often 
added to it. 

As elsewhere remarked, sulphur, when converted into sulphurous 
acid by burning, and applied to the cutaneous surface in the form of an 
air bath, is often a valuable remedy. As such it has been used in 
various diseases, in which an excitant influence to the skin is indicated. 
In cutaneous diseases of an inveterate kind, as scabies, impetigo, and 
the different squamous affections, it has succeeded when other remedies 
had failed. The gas is exceedingly irritating, and, therefore, must be 
prevented from entering the air passages. 

Sulphur is, however, most frequently employed externally, in one of 
the following forms. 



POTASSII SULPHURETUM. 329 

UNGUENTUM SUL'PHURIS, SULPHUR OINTMENT. {Sulphur $j ; Mipk ffiij.) 
This ointment, called also Itch Ointment, Brimstone Ointment, is the 
mildest form that is used, and is especially applicable to scabies in 
children. Both it and the next preparation may be rubbed over the 
affected parts, before the fire, night and morning, for five or six days ; 
the patient continuing to wear the same clothes. He may then be 
thoroughly washed, and have an entire change of clothes. In the gene- 
rality of cases, three or four thorough inunctions will be sufficient ; and, 
according to some, only one, — provided the body be covered all over 
with it. Some essential oil, as oleum limonis or oleum bergamii, is added 
at times ; but the smell of the sulphur is predominant. 

UNGUEN'TUM SUL'PHURIS COMPOS'ITUM, COMPOUND SULPHUR OINTMENT. (Sul- 
phur. 3j ; Hydrarg. ammon.; Acid. Benzoic, aa ^j ; 01. Bergamii, Acid. 
Sulphuric, aa. f.gj ; Potasses, nitrat. t\] ; Adipis fgss.) This is a more 
irritating itch ointment than the last. 

Compound sulphur ointment, of the London Pharmacopoeia, is formed 
of Sulphur fgss ; Veratr. alb. pulv. ^ij ; Potass, nitrat. ^j ; Sapon. 
mollis $ss ; Adipis $iss ; 01. Bergamii ^Ixxx. 



63. POTAS'SII SULPHURETUM.— SULPH'URET OF .POTAS'SIUM. 

Sulphuret of potassium, Tersulphuret of potassium, Potassii tersul- 
phuretum, Hepar sulphuris, Liver of sulphur is made by rubbing carbon- 
ate of potassa, previously dried, with sulphur, in due proportions ; 
melting the mixture in a covered crucible over the fire ; pouring it out ; 
and, when cold, keeping it in a well-stopped bottle. This is the mode 
of preparation adopted in all the British Pharmacopoeias, as well as in that 
of the United States. It is of a brownish-yellow colour when freshly 
broken ; its taste is acrid, bitter, and alkaline ; it is devoid of smell when 
perfectly dried ; but, when moistened, acquires the odour of sulphohy- 
dric acid. Under exposure to the air, it takes oxygen, and undergoes 
changes which end ultimately in the formation of sulphate of potassa, 
and free sulphur. It is soluble in water, to which it imparts an^range- 
yellow colour, and a strong sulphureous odour. The stronger acids 
decompose it, throwing down sulphur, and disengaging sulphohydric 
acid. 

In large doses, sulphuret of potassium is an acro-narcotic poison ; but 
in medicinal doses, it has been administered in chronic cutaneous dis- 
eases. It is supposed, also, to be possessed of eutrophic powers in 
diphtheritic affections ; and in glandular enlargements of a scrofulous 
character. It has, likewise, been used externally in various skin dis- 
eases, especially in scabies, in which sulphur is so beneficial. The dose 
may be three to ten grains, made into pill and given three times a day ; 
or it may be 'dissolved in syrup. In the form of bath, it has been used 
in skin complaints in the proportion of one part of the sulphuret to one 
thousand of water. A lotion, (Potass, sulph. 31J ; Aquse Oj) ; and an 
ointment, (Potass, sulphur. 5ss; Adipis 3j,) are sometimes used. 



330 SPECIAL EUTROPHICS. 



64. SODiE HYPOSULPH'IS.— HYPOSULPHITE OF SODA. 

There are several modes of preparing this salt, which is largely used 
for photographic purposes. One of the best is to form neutral sulphite 
of soda by passing a stream of sulphurous acid gas into a strong solu- 
tion of carbonate of soda, and then to digest the solution with sulphur 
at a gentle heat for several days. By careful evaporation, at a moderate 
temperature, the salt is obtained in large and regular crystals, which are 
very soluble in water. 

Hyposulphite of soda is said to have been administered, with constant 
success, by physicians of Paris, who are the most versed in the treat- 
ment of chronic cutaneous diseases. It was first employed by MM. 
Chaussier and Biett under the name sulfite sulfure de soude; but it had 
fallen into neglect, when its use was revived by M. Quesneville, and 
the results have been entirely conformable to those obtained by MM. 
Chaussier and Biett. It has been highly extolled in chronic cutaneous 
and scrofulous affections ; and is said to be a most efficacious auxiliary 
to external sulphurous preparations. It is best given in syrup, made of 
one ounce of the hyposulphite to twelve ounces of water, and twenty- 
three ounces of sugar ; the dose of which is f.^j to f.^ij. 

The salt may also be prescribed in solution in the dose of from two 
scruples to a drac m. It has been occasionally used as an artificial sul- 
phur bath; from 3j to §iv being dissolved in a sufficient quantity of 
water. If a small portion of dilute sulphuric acid or vinegar be added 
to the bath, whilst the patient is immersed, sulphurous acid and sulphur 
are set free. 

65. ANTHRAKOK'ALI. 

This article was introduced in 1837. Two forms are employed, the 
simple and the sulphuretted. The former is prepared by dissolving car- 
bonate ofpotassa in 10 or 12 parts of boiling water, and adding as much 
slaked lime as will separate the potassa. The solution, thus obtained, 
contains only caustic potassa. The filtered liquor is placed on the fire 
in an iron vessel, and suffered to evaporate until neither froth nor effer- 
vescence occurs, and the liquid presents a smooth surface like oil. To 
this is added the levigated coal in the proportion of 160 parts to 192 
parts of potassa. The mixture is stirred, and removed from the fire ; 
and the stirring is continued until a black homogeneous powder results. 
This is kept in a dry place. 

To obtain sulphuretted anthrakokali, 16 parts of sulphur must be ac- 
curately mixed with the coal, and the mixture be dissolved in the 
potassa as directed above. 

Anthrakpkali has been prescribed as a eutrophic in chronic cutaneous 
affections. It is also said to have been given beneficially in scrofula 
and chronic rheumatism. 

The dose of the simple and sulphuretted preparations is a grain and 
a half three times a day. 



P0TASS2E CHLORAS. 331 



66. FULIGOK'ALI. 

This is a substance analogous to the last. It is prepared by boiling 
for an hour 20 parts of potassa, and 100 parts of shining soot in pow- 
der, in a sufficient quantity of water. The decoction is then suffered to 
cool. It is diluted with water, so that filtration may be better accom- 
plished; is filtered, evaporated, and dried, and then enclosed in dry 
and warm bottles. 

Sulphuretted fali gokali is prepared of fuligokali 60 parts; potassa 
14 parts ; sulphur, 5 parts. The sulphur and potassa are dissolved in 
a little water ; the fuligokali is then added, and the whole evaporated, 
— the residuum being dried and enclosed in dry and warm bottles. 

Fuligokali has been prescribed both internally and externally, but 
chiefly in the latter mode, in various chronic cutaneous diseases. An 
ointment may be made of either the simple or 'the sulphuretted article, 
by mixing one or two parts with thirty of lard. M. Gibert ascribes to 
them resolvent, detergent, and slightly excitant virtues. Mr. E. Wil- 
son thinks it probable, that both anthrakokali and fuligokali owe much 
of their therapeutic agency to the alkali which forms their basis. He 
has employed fuligokali in several cases, and especially in psoriasis 
palmaris, and with more success than he has obtained from the usual 
remedies. What might be regarded as a weak solution of fuligokali 
was used by Drs. Physick, Dewees, and others, under the names of 
medical lye, soot-tea, alkaline solution, and dyspeptic lye (Mr. Duhamel, 
in Amer. Journal of Pharmacy, Jan., 1843). 

67. POTAS'SiE CHLORAS.— CHLORATE OF POTAS'SA. 

Chlorate, oxymuriate or hyperoxymuriate of potassa may be prepared 
by passing chlorine gas slowly through a cold solution of potassa placed 
in a Woulfe's bottle. The liquid is allowed to stand for twenty-four 
hours in a cool place ; and is then found to have deposited crystals of 
chlorate of potassa ; which are drained, washed with water, dissolved 
in hot water, and recrystallized. Professor Graham advises, that carbo- 
nate of potassa should be mixed intimately with an equivalent quantity 
of dry hydrate of lime, and the mixture be exposed to chlorine gas. 
The products are carbonate of lime, chlorate of potassa, and chloride 
of potassium. Chlorate of potassa may be separated by crystallization. 
It crystallizes in nearly rhomboidal plates ; and has a cool taste, 
somewhat similar to that of nitre. One hundred parts of water at 59° 
Fah. dissolve six parts. 

This salt was at one time largely prescribed in consequence of its 
presumed action as a eutrophic, by imparting oxygen to the blood. Ex- 
periments have, however, shown, that it has been detected in the urine 
of patients, which, of course, negatives the presumption. Finding that 
the salt gives a beautiful arterial hue to venous blood, Dr. Stevens pre- 
scribed it in fever, cholera, and other malignant diseases, in which 
there appeared to be a deficiency of saline matter in the blood ; but the 
testimony in its favour is by no means potent. Dr. Henry Hunt has 



332 SPECIAL EUTROPHICS. 

extolled it in cancrura oris — gangrenous stomatitis — given in solution, 
or divided doses, to the extent of from 20 to 60 grains in the twenty- 
four hours, according to the age of the child. It lessens — he says— 
the fetor and salivation, and promotes the granulation of the sores. 
Dr. Watson states, that he has been in the habit of directing a solution 
of the salt in water, in the proportion of a drachm to the pint, as a 
drink for patients in scarlet fever, and in the typhoid forms of continued 
fever. The remedy was suggested to him by Dr. Hunt, who stated 
that he had long given it with advantage. Under the use of a pint, or 
a pint and a half, of the solution daily, Dr. Watson noticed, in many 
instances, a speedy improvement of the tongue, which, from being 
furred, or brown, or dry, became cleaner and moist. By Dr. Scruggs, 
of Germantown, Tennessee, the chlorate has been extolled both inter- 
nally, and as a collutory in the erysipelatous inflammation of the mouth 
and fauces that occur in the " black tongue " of the Western States.. 
It has been considered, also, to be diuretic and refrigerant, and to 
resemble nitrate of potassa, than which it is probably not possessed of 
greater, or of other virtues. The dose is from ten grains to half a 
drachm. As a mouth wash, a drachm may be dissolved in four fluid- 



ounces of water. ^ 

68. CAN'THARIS.— SPANISH FLIES 



Cantharides — elsewhere described (Vol. i.p. 281,) — have been oc- 
casionally prescribed internally in chronic cutaneous diseases — as lepra, 
psoriasis, chronic eczema, and squamous diseases of the skin. MM. 
Biett and Rayer recommend it strongly ; but an objection to it is the 
irritation which it is apt to induce in the gastric and urinary organs. Its 
good effects are perhaps owing in part to the revellent influence thus 
effected ; but they may also be dependent upon the modification induced 
by it on the blood, and through it on the morbid actions going on in 
the tissues. With this view, small doses, not exceeding a grain, two 
or three times a day, in the form of pill ; or ten or fifteen drops of Tine- 
tura cantharidis may be given. 

69. SAC'CHARUM.— SUGAR. 

The main properties of sugar were described in the first volume of 
this work, under Demulcent Expectorants, (p. 247). It is as an 
agent, capable of modifying the functions of nutrition, that it has now 
to be regarded ; and the author is prepared to say, from an experience 
of many years, that it is one of the most important for this purpose that 
we possess. In the first edition of his " General Therapeutics," (1836,) 
he stated, that in many forms of cachexia he had succeeded in pro- 
ducing a thorough revolution in the system of nutrition, by allowing 
the patient a certain quantity of sugar, formed into syrup, and given to 
the adult in such quantity, that three or four ounces of the sugar might 
be taken daily, and for a long period ; — five or six weeks at the least. 
Under this diet or medicine, — for it is better, in order to infuse confi- 
dence, to give it as medicine, and to medicate it by the addition of a 



SACCHARUM. 333 

little rose-water, or some aromatic oil, — the patient has rapidly gained 
weight, and the action of the system of nutrition has been so much 
changed, that the cachexia, induced by poor living, and a residence in 
confined unhealthy situations, as well as that which characterizes 
atrophy without any manifest cause, has been removed ; a complete 
renovation has taken place ; inveterate cutaneous diseases have disap- 
peared, and old ulcers have filled up, and cicatrized. The sugar, in 
these cases, appears to act as a substantive and adjective aliment, — 
that is, it furnishes a richer and more abundant chyle ; and, moreover, 
like a condiment, puts the digestive organs in a condition to derive a 
larger quantity of nutriment from the food than they would otherwise 
do. It is in consequence of this altered condition of the circulating 
fluid, that the action of the vessels of nutrition into which it passes is 
modified ; and the pathological catenation that constitutes the cachexia 
is broken in upon. If sugar be added to venous blood out of the body, 
it changes it to a bright arterial hue. 

When the functions of nutrition are morbidly affected, as in chronic 
cutaneous eruptions, there are two great methods in which we may 
reach the disease, — the one is by the application of external remedies 
to the diseased capillaries, — the other, by changing the impression made 
upon them internally by the fluid that circulates within them. Sugar — 
like arsenic, creasote, iodine, and other eutrophics — acts in the latter 
way. The great success which the author has met with in the removal 
of inveterate eruptions from the administration of sugar, has induced 
him to infer, that many of the alterative syrups — officinal and empirical 
— may be mainly, and some of them wholly, indebted for their efficacy 
to the sugar which they contain ; especially as he has not noticed the 
same good effects, when the other ingredients of many of these syrups 
have been given without the sugar. 

In the number of the American Medical Intelligencer for April 15, 
1837, he published the case of a lady, from a distant city, who visited 
Philadelphia to place herself under the care of an eminent professional 
friend, who advised her to consult the author. Four years previously, 
her husband, who was a dissolute character, had contracted syphilis, 
and communicated it to her. She had applied to several physicians ; 
but without experiencing much relief. Ulcerations existed on various 
parts of the body. There were nodes on the tibia and forehead ; added 
to which she had been unable to sleep, in consequence of severe pains 
in the bones, for the eighteen months prior to her arrival in Philadelphia. 
In order that full opportunity might be afforded for her recovery, she 
took a house ; had her furniture sent to her, and determined to reside 
during the winter in Philadelphia. She had already taken various 
forms of mercurials, and amongst the rest, corrosive chloride of mercury, 
in the use of which she had persisted for a long time. It was, however, 
directed again by the author, so that she should take one-sixteenth part 
of a grain three times a day; and in addition to this, she was ordered 
to dissolve a pound of rock candy in a pint of water, and take a wine- 
glassful four times a day. Under this course, the ulcers soon began to 
heal ; the nodes disappeared ; the pains in the bones ceased ; her nights 
were passed in comfort ; and at the end of five weeks, she was so much 



334 SPECIAL EUTROPHICS. 

restored, that she determined to rejoin her family; quitted her house; 
removed her furniture, and went away with feelings of perfect recovery. 
She was recommended, however, to persevere in the plan advised. 
Since then, the author has not heard from her. 

Many similar cases have occurred to the author in which he has 
found the eutrophic influence of the saccharine treatment most signally 
manifested. The remedy, however, is so simple, that it may be diffi- 
cult to induce practitioner or patient to place much confidence in it; 
but if the former will reflect upon the indications which he desires to 
fulfil, and on the effect which sugar is capable of inducing, like other 
eutrophics whose properties have been considered, he ought not to 
hesitate to prescribe it, and the result will gratify, and, in many in- 
stances, astonish him. At the recommendation of the author, it has 
been prescribed by several physicians, and with results analogous to 
those he has depicted. A case of almost hopelesss cachexia in a child 
has been published by Mr. Rowbotham in the London Lancet, in which 
a diet of fruits and saccharine matter, — as honey, sugar and treacle — 
" snatched from the grave, and from a state, which perhaps no mortal 
was ever in before, and restored to health and life ;" and according to 
the British and Foreign Medical Review, for Oct. 1842, a treatise on 
rheumatic diseases had appeared at Leipzig in 1841, by Dr. Greiner, 
in which there is a " warmth of eulogium on sugar as one of the direct 
means of improving the blood," which " somewhat surprised" the 
reviewer. Dr. Greiner, it appears, strongly recommended it in both 
acute and chronic rheumatism, where sthenic excitement prevails, and 
antiphlogistic means are indicated ; but to be useful — he states— it 
must be taken in doses of from one to two ounces, three or four times 
daily, in syrups, conserves, — or plain. 

In the different diseased conditions for which the author administers 
it to modify the action of the system of nutrition, he is in the habit of 
recommending it in the form of syrup — either the officinal syrup of the 
pharmacopoeia, or one made extemporaneously by dissolving a pound 
of rock candy in a pint of water. Of this, a wine-glassful may be taken 
three or four times a day, between meals, and the quantity be gradually 
increased. It is proper, that the individual should take animal food 
along with it, otherwise scorbutic cachexia may be induced ; but the 
quantity of vegetable food must be diminished. The only accident that a 
is apt to arise during its administration is diarrhoea ; which soon, how- 
ever, passes off, if the sugar be discontinued for a short time. 

It need scarcely be said that in morbid states, that have endured for 
a length of time, no great benefit can be derived excepting from a long 
persistence in the use of any remedy. Accordingly, much effect may 
not be perceived until four or five weeks have elapsed, when, if advan- 
tage is to be derived, it will begin to appear. 

70. SARSAPARIL'LA. 

This much employed root is referred, in the United States' Pharma- 
copoeia, to Smilax officinalis, and other species of Smilax; Sex. Syst. 
Dicecia Hexandria ; Nat. Ord. Smilaceae ; a genus of creepers growing 



SARSAPARILLA. 



335 



on moist river banks and woods in the hotter parts of North and South 
America, especially in Mexico, Columbia, Guiana, Brazil, and the 
Southern States of the Union. At least three species seem to be made 
out as furnishing the sarsaparilla or sarza of commerce: — 1. Smilax 
officinalis, which grows in New Granada, on the banks of the Magdalena, 
and is transmitted in large quantities to Carthagena and Mompox, whence 
it is shipped to Jamaica and Spain. 2. Smilax syphilitica, which was 
found by Humboldt and Bonpland in New Granada, and by Von Mar- 
tius in the Brazils, and which is exported to Europe from the ports of 
Brazil. 3. Smilax medica, which grows on the Eastern slope of the 
Mexican Andes, and is carried to Vera Cruz and Tampico for expor- 
tation. 

There are still other species of smilax ; — for example, Smilax sarsa- 
parilla, which is a native of the Southern States ; but there is no evi- 
dence that it yields any of the sarsaparilla of the shops ; and the root 
would assuredly be dug up, and introduced into the market, if it had 
been found to possess the same properties as the imported article. 
(Wood and Bache.) Another species has been mentioned by Pop- 
pig, under the name Smilax cordato-ovata. It grows in Brazil, and 
supplies, in that country, a part of the root which is used in medicine. 
All the species of sarsaparilla plant have a rhizoma, which sends out 
numerous long horizontal roots or runners, and these roots constitute 
the sarsaparilla of the shops. 

Several varieties of sarsaparilla are met with in European commerce, 
all of which have been described by recent pharmacologists. Of these, 
the most important are the following: — 

1. Jamaica Sarsaparilla, Red, or Red-bearded Sarsaparilla, which 
is probably the root of Smilax officinalis, and is made up in bundles of 
about a foot, or a foot and a half long, and four or five inches broad, the 



Fig. 161. 



Fig. 162. 





Jamaica Sarsaparilla. Honduras Sarsaparilla. 

a. Cuticle. b. Subcuticular tissue. c. Hexagonal cellular tissue. d. Cellular rin<* 

e. Woody zone. /.Medulla. The hexagonal cellular tissue abounds in starch.— (Christison?) 

roots scarcely equalling in thickness a goose-quill, and distinguished 
from the other varieties by the red colour of the epidermis. It receives 
the name Jamaica sarsaparilla, owing to its being sent thither from Hon- 
duras. Occasionally, it is exported from Guatemala. This is the most 



\ 

336 SPECIAL EUTROPHICS. 

esteemed variety in English pharmacy. 2. Honduras Sarsaparilla, 
Mealy Sarsaparilla, is exported directly from Honduras Bay, and some 
of it scarcely differs from Jamaica sarsaparilla. Generally, the roots are 
folded, and formed into bundles two or three feet long, in which roots 
are found of inferior quality, with stones, pieces of wood, &c. The 
colour is dirty or grayish-brown. The epidermis is thin, and within it 
is a thick, white, amylaceous layer, which gives it a mealy appearance 
when broken, — whence one of its names. Its botanical source is not 
accurately determined. It is the variety most commonly used in this 
country. 3. Brazil Sarsaparilla, Lisbon, Portugal, Rio Negro sarsa- 
parilla, strongly resembles the last variety in form, colour, and meali- 
ness ; but it is generally exported unfolded, and tied in cylindrical 
bundles, three to five feet long, and about a foot in diameter. It has 
fewer radicles or rootlets than either of the other varieties. It is sup- 
posed to be the produce of Smilax syphilitica, and perhaps, also of 
S. ovato-cordata, and is exported from Maranham chiefly. Being sent 
to Portugal, and especially to Lisbon, it obtains a name from those 
places. 4. Lima, or Valparaiso Sarsaparilla was originally exported 
from Lima, but is now frequently obtained from Valparaiso; and at 
times from Costa Rica. Dr. Pereira states, that he knew of one impor- 
tation of 99,000 lbs. from the last place. It is an inferior variety, com- 
monly imported in large bundles, and resembles somewhat the Jamaica 
or Honduras variety. It is imported folded in bundles of about three 
feet long and nine inches in diameter, with the rhizoma or chump inthe 
interior of the bundle. Its colour is brown or grayish-brown. Its bo; 
tanical source is not known ; but it has been presumed to be from 
Smilax officinalis. 5. Vera Cruz Sarsaparilla indicates by its name 
the place whence it is exported ; but it is said not to be often met with. 
The roots are not folded, and have the rhizoma or chump attached. 
They are thin ; tough ; of a light grayish-brown colour, and devoid of 
starch in the cortex. It is the produce of Smilax medica. 

Besides these chief varieties, other minor sarsaparillas are described 
by pharmacologists, but they are not of much interest to the physician. 
Smilax China, China root, a native of Japan, has been employed in the 
same cases as sarsaparilla. 

As met with in the shops, sarsaparilla is almost devoid of odour, but 
possesses a mucilaginous slightly bitter taste, and, when chewed for 
some time, causes a sensation of acridity in the mouth and fauces, 
which persists for a considerable period. According to Dr. Hancock, 
the Rio Negro sarsaparilla, which in his opinion is the only kind that 
possesses any activity, has a peculiar nauseous acrimony, which no 
other sarsaparilla possesses; but if Dr. Hancock be right, large quan- 
tities of the other varieties, which are alone prescribed by many physi- 
cians — who are notwithstanding ready to depose to its valuable pro- 
perties — must have been devoid of action on the economy ; and if, as 
has been thought, the root is efficient in proportion as it possesses the 
acrimony described above, which is said to be a volatile, easily destruc- 
tible principle, then almost all the preparations, so long given, and im- 
plicitly relied on by many, must — as regards the sarsaparilla — have been 
wholly inoperative. Such might be the case with Dccochm sarsaparilla 



SARSAPARILLA. 337 

composition, and Syrupus sarsaparillce compositus of the Pharmacopoeia 
of the United States, and with the decoctions and extracts of other 
pharmacopoeias in which heat is employed. According to Dr. Hancock, 
if the sarsaparilla be really of good quality — which, however, he adds, 
is very seldom the case with what is to be got in Europe — the only cor- 
rect preparations of it are — an infusion of the bruised root made by keep- 
ing it for some hours at 212° without boiling; and one prepared slowly 
without heat at all. 

These facts would of themselves throw strong doubts in regard to 
much of the testimony that has been brought forward in favour of this 
article of the Materia Medica ; nor is any light thrown on the subject 
by the investigations of the chemical analyst. It has been repeatedly 
examined ; but discrepant statements of its composition have been the 
result. It seems to contain Volatile oil of sarsaparilla, which has the 
odour and acrid taste of the root ; Smilacin, called also Pariglin, Sal- 
separin, and Parallinic acid, which appeared to Palotta to act as a 
sedative in doses of two to thirteen grains ; resin, and extractive — on 
which it has been thought a part at least of the medicinal properties de- 
pend, and starch. Smilacin is procured by decolorising a concentrated 
hot alcoholic tincture of sarsaparilla by animal charcoal. On cooling, 
the tincture deposits impure smilacin, which can be purified by repeated 
solution and crystallization. 

The active principles of sarsaparilla reside chiefly in the cortical por- 
tion. They are imparted to w T ater and dilute alcohol. 

The quantity consumed is very great. In the year 1840, duty 
was paid in England on 121,814 lbs. ; and the countries from which it 
was obtained in 1831 are thus stated by Dr. Pereira from a parliamen- 
tary return : — 

Portugal, 16,110 lbs. 

Italy and the Italian Islands, - 107 

British Northern Colonies, - 71 

British West Indies, 45,063 

United States of America, - 29,122 

Mexico, 43,254 

Guatemala, ------- 14 

Brazil, 31,972 

Peru, 11,141 



Total import, 176,854 

Returned for home consumption, - - - 107,410 

Dr. Christison quotes the statement of Dr. Pereira in regard to the 
quantity consumed in Great Britain in 1831 ; and adds that in 1821 
the apothecary of one of the great London Hospitals informed him, that 
he had paid at that time .£1,500 for a single year's consumption of it. 

In April 1849, Dr. Bailey, inspector of drugs at the port of New 
York, rejected 1450 lbs. of Sarsaparilla from Tampico. 

Were we to be guided by the quantity consumed, sarsaparilla ought 
Vol. II.— 22 



338 SPECIAL EUTROPHICS. 

to be esteemed a most valuable therapeutical agent; yet the author has 
much difficulty in speaking positively on the subject. Were he to judge 
from the results of his own observation, he would say, that it is inert; 
and a consideration of the remarks already made in regard to the differ- 
ent varieties of the drug, and forms of preparation, would tend to a 
similar conclusion; yet when he observes so many persons offering their 
testimony in its favour, he is not prepared to decide, as Dr. Cullen did 
that it is totally devoid of medicinal efficacy. Much, doubtless, is to be 
ascribed to the diet and regimen generally associated with it; much 
in syphilitic and syphiloid diseases, to its frequently leading to the exclu- 
sion of mercury ; and much, the author is disposed to think, to the 
substances that are associated with it. " No doubt" — say Messrs. Bal- 
lard and Garrod — "chronic cutaneous affections, glandular swellings, 
enlargements and painful diseases of the joints, bones, fascia?, &c, 
sometimes disappear under its use ; but still we must suspend our judg- 
ment respecting the part which it takes in their cure, until the influence 
of time, regulated diet, and other medicinal agencies usually combined 
shall have been correctly ascertained. 

In public and in private practice, the author has carefully watched 
the effects of sarsaparilla, given singly, in infusion and in extract, but 
he is not prepared to say that he has, in a single instance, observed effects 
that could be fairly referred to it. Such has not been the case when 
syrup t)f sarsaparilla has been exhibited largely ; but here a considera- 
ble quantity of saccharine matter was taken along with it, to which the 
anthor is disposed, for reasons elsewhere given, to refer the therapeuti- 
cal agency. The remark of Mr. Lawrence, that physicians have no 
confidence in it, but surgeons a great deal, is not sufficiently explained 
by the circumstance mentioned by Dr. Pereira,that physicians are much 
less frequently called in to prescribe for those forms of disease, in the 
treatment of which surgeons have found sarsaparilla so efficacious. 
Moreover, Dr. Christison remarks, that if the fact be applicable to Lon- 
don, it does not apply elsewhere, and not to Edinburgh certainly, where 
some of the most eminent surgeons have abandoned it except as a 
placebo. "My own opinion," he says, " deduced from not unfrequent 
opportunities of practice in the Edinburgh Infirmary, where syphilitic 
and mercurio-syphilitic cases come under the cognizance of the physi- 
cian chiefly, is, that the question — confessedly a difficult one, like that 
relative to the action of alterative remedies in general — is still far from 
being satisfactorily decided ; that more careful observations are required, 
more especially in reference to the now acknowledged efficacy of simple 
non-mercurial treatment in secondary, pseudo, and mercurial, syphilis ; 
and that the probability is much in favour of the drug turning out very 
inferior in virtue to what its admirers imagine ;" and he adds, that the 
question is not unimportant in an economical point of view, seeing that 
so much of it is consumed. 

Perhaps there is no article of the Materia Medica which is employed 
so lavishly, and so frequently had recourse to in chronic diseases, when 
the practitioner is in doubt what to do. As a eutrophic, it has been 
chiefly had recourse to in cachexia of various kinds, but especially in 
the syphilitic ; and is,.at times, associated with mercury, especially with 



SARSAPARILLA. 339 

the corrosive chloride. When employed alone, it offers an exemplifi- 
cation of the simple mode of treating syphilis, in contradistinction to 
the revellent by mercury, iodine, &c. 

It has, likewise, been freely given in syphiloid affections, and in chro- 
nic cutaneous diseases ; and, in the form of syrup, has been frequently 
efficacious, in the last affections especially. Whenever, indeed, a mo- 
dified action in the system of nutrition generally has appeared to be in- 
dicated, it has been prescribed. 

It may be given in powder in the dose of £ss to ^j, three or four 
times a day; but it is not often prescribed in this form. When fresh, 
the root is said to induce nausea and vomiting; and signs of narcosis 
have resulted from it : but in the state in which it is met with in the 
shops, it rarely or never disagrees except from quantity. A fact, men- 
tioned by Dr. Pereira, may render the practitioner cautious in prescrib- 
ing the powder : — viz., that some druggists employ, in its preparation, 
the roots from which the extract has been obtained. This powder is, of 
course, almost devoid of taste. 

INFUSUM SARSAPARIL'LA, INFU'SION OF SARSAPARILLA. (Sarsaparill. con- 
tus. §j ; Aqux bullient. Oj ; — prepared either by maceration or by dis- 
placement with cold water.) The dose of the infusion is f.^iv to f.gvj 
two or three times a day. 

DECOC TUM SARSAPARILLA COMPOSITUM, COMPOUND DECOCTION OF SARSAPA- 
RIL'LA. (Sarsap. incis. et contus. gvj ; Sassafras, incis., Guaiac. lign. 
rasur., Glycyrrhiz. contus. aa. §j ; Mezer. incis. 3hj ; *flquce Oiv. Boil 
for a quarter of an hour and strain.) This preparation is an imitation 
of the Lisbon Diet Drink, which was long celebrated in all cases in 
which sarsaparilla was indicated ; — its powers being enhanced— it was 
conceived — by the addition of the sassafras, guaiacura, and mezereum, 
which were supposed to possess analogous properties. If the objections 
made to the application of a boiling heat be well founded — as they are 
generally admitted to be — decoction must be an imperfect mode of pre- 
paration. The dose of this preparation is f.^iv to f.§vj three or four 
times a day. The syrup or extract is often associated with it. 

SYRU'PUS SARSAPARILLA COMPOSITE, COMPOUND SYRUP OF SARSAPARILLA. 

(Sarsaparill. contus. ggij ; Guaiac. lign. rasur. ^iij ; Ros. centifol., Sennse, 
Glycirrhiz. contus aa lij ; 01. Sassafras, 01. anisi aa^lv; 01. gaul- 
therice ^liij ; Alcohol, dilut. Ox ; Sacchar. ggviij. The first five articles 
are macerated in the alcohol for a certain length of time, and by means 
of a water-bath the filtered tincture is evaporated to four pints ; to the 
filtered liquor the sugar is added, so as to form a syrup ; the oils being 
added last. It may also be made by displacement, according to the 
formula in the United States PharmacopcEia.) 

Dr. Christison considers the simple syrup of sarsaparilla to be " an 
unnecessary addition to the list ;" and Dr. Thomson remarks, that it can 
be better and more easily supplied by rubbing up a few grains of the 
extract with some simple syrup. The preparations of the British Col- 
lege are probably inert as regards the sarsaparilla, as the boiling cannot 






340 SPECIAL EUTROPHICS. 

fail to destroy any virtues that it may possess. This objection does not 
apply so much to the process of the United States Pharmacopoeia ; yet, 
the heat of the water-bath may affect its virtues. The roses and volatile 
oils are added for the sake of flavour. There is no question whatever 
that this syrup has been productive of good effect in many cachexia? ; 
but the author is not prepared to say how much of this is ascribable to 
the sarsaparilla and guaiacum, and how much to the saccharine matter 
which is sometimes given very freely. The ordinary dose is, however, 
f.^ss to f.§j three or four times a day. It may be substituted for the 
Strop de Cuisinier. 

EXTRACTUM SARSAPARILLA, EXTRACT OF SARSAPARILLA. (Prepared, ac- 
cording to the Pharmacopoeia of the United States, by displacement, by 
means of diluted alcohol and water, evaporating the filtered liquor to the 
proper consistence.) It is very questionable whether any extract of sar- 
saparilla can be possessed of much virtue. If the properties reside in 
volatile matter it must be driven off by the long coction. The Edin- 
burgh and Dublin Colleges have a Fluid extract of sarsaparilla, in which 
the concentration is not carried so far. A little dilute alcohol is added 
1o make it keep. 

The dose of the extract of sarsaparilla of the Pharmacopoeia of the 
United States is from ten to twenty grains, three or four times a day. 
Dr. Pereira, contrary to most observers, states his belief, that when the 
ordinary extract of sarsaparilla of the London and Dublin Pharmacopoeias 
is properly prepared from Jamaica sarsaparilla, it is a most valuable and 
efficient remedy. He recommends, that, when given, it should be rubbed 
down with water, and flavoured by the tincture of orangepeel, or by 
some volatile oil, as oil of cloves, allspice, lemon or cinnamon. The 
anthor has used it extensively, but he cannot accord with that gentle- 
man in his high appreciation of it. 

Compound extract of sarsaparilla is kept in the shops. It is made 
by mixing with Extract of sarsaparilla, an Extract of mezereon bark, 
Liquorice root, and Guaiacum shavings, adding a small quantity of 
Oil of sassafras. Three quarters of an ounce of this to a pint of water 
are considered to equal in virtues a pint of the compound decoction of 
the British Pharmacopoeias. 

71. GUAI'ACI LIGNUM— GUAI'ACUM WOOD. 

The general properties of guaiacum wood have been described under 
Excitant Diaphoretics, (Vol. i. p. 319). As a eutrophic, it has been 
given, like sarsaparilla, in syphilitic and syphiloid diseases ; and in most 
forms of cachexia. It is less relied on, however, than sarsaparilla, and 
is usually associated with it. It has also been freely administered in 
chronic cutaneous affections. It is probably possessed of very little 
efficacy. 

There is no separate preparation of it in the Pharmacopoeia of the 
United States; but the Edinburgh and Dublin Colleges have a Decoc 
tum Guaiaci, which is considered to be the relic of the old Decoction 
of the woods. In the pharmacopoeia of the former, it is made as fol- 



ARALIA NUDICAULIS. 



341 



Fig. 163. 



l ows: — Guaiacum trimmings 3iij ; Sassafras^ rasped §j ; Liquorice 
root bruised §j ; Raisins 3ij ; Water Ox. Boil the guaiacum and rai- 
sins with the water to five pints, adding the liquorice and sassafras 
towards the close ; then strain. The dose of this is f.^iv to 3viij and 
more, three or four times a day. 

Guaiacum wood enters into the composition of Decoctum sarsapa- 
rillce compositum, and Syrupus sarsaparillce compositus of the Pharma- 
copoeia of the United States. 

72. MEZE'REUM.— MEZE'REON. 

Mezereon belongs, like guaiacum wood, to the excitant diaphoretics ; 
and its general properties have, consequently, been described elsewhere, 
(Vol. i. p. 321). It is given in the form of decoction — Decoctum 
Mezerei of the Edinburgh and Dublin Pharmacopoeias, which is made 
as follows: — Mezereon bark in chips Jij > Liquorice root bruised zss; 
Water Oiij ; boil gently to Oij. The dose is f.^iv to f.^viij, three or 
four times a day. 

Mezereon enters into the same officinal preparations as guaiacum 
wood, and is seldom given alone. 

73. ARA'LIA NUDICAU'LIS.— FALSE SARSAPARIL'LA. 

This is the root of Aralia nudicaulis, False sarsaparilla. Wild sar- 
saparilla, Small spike- 
nard ; Sex. Syst. Pen- 
tandria Pentagynia ; 
Nat. Ord. Araliaceae ; 
an indigenous peren- 
nial plant, which grows 
throughout the great- 
er part of the United 
States, flowering in 
May and June. It is 
officinal in the secon- 
dary list of the Phar- 
macopoeia of the Unit- 
ed States ; is about as 
thick as the little fing- 
er ; more or less con- 
torted ; of a yellowish 
brown colour external- 
ly ; of a fragrant odour, 
and an aromatic sac- 
charine taste. 

False sarsaparilla has 
not been analyzed, but 
appears to possess pro- 
perties that might en- Aralia ""dicauiis. 
title it to rank with guaiacum and mezereum amongst excitant diapho- 




342 SPECIAL EUTROPHICS. 

retics. The common belief is, that, like them and sarsaparilla, it may 
be employed also as a eutrophic in syphilitic and syphiloid diseases, 
and in chronic cutaneous affections especially. The author has never 
prescribed it, nor has he seen it prescribed. 

The root of Aralia racemosa, American spikenard, is said to resem- 
ble Aralia nudicaulis in properties. 

74. SAS'SAFRAS RADI'CIS CORTEX.— BARK OF SAS'SAFRAS ROOT. 

This agent — like guaiacum wood and mezereon — was at one time 
supposed to be possessed of powerful eutrophic virtues, especially in 
syphilitic and chronic cutaneous diseases ; and it is still associated with 
the articles above mentioned, and with sarsaparilla, in one officinal pre- 
paration of the Pharmacopoeia of the United States, Decoctum sarsapa- 
rillse composition. Its properties — both diaphoretic (Vol. i. p. 323,) 
and eutrophic — are probably altogether dependent upon the volatile 
oil which it contains ; but its agency is very limited, and it is now 
never given alone in the very cases in which it was formerly so much 
extolled. 

Oil of sassafras forms part of Syrupus sarsaparillce compositus of the 
Pharmacopoeia of the United States. 

75. DULCAMA'RA.— BITTERSWEET. 

Bittersweet, of the Pharmacopoeia, is the stalks of Solanum dulcamara, 
Woody nightshade or Bittersweet ; Sex. Syst. Pentandria Monogynia; 
Nat. Ord. Solanacese; — a perennial climbing plant, which is common 
in Europe, and in this country, both wild and cultivated ; flowering 
from June to August. The stalks — which are the only officinal portion 
— are collected in autumn, after the leaves have fallen off. When 
bruised in their fresh state they have a disagreeable odour, which is 
lost by drying. The taste is at first bitter, and afterwards sweet, which 
gives occasion to their name. As we meet with the dried stalks in the 
shops, they are rugous externally, having a greenish-gray epidermis, 
an interior light woody portion, and a central light and spongy pith. 

It imparts its properties to water and to alcohol ; but the tincture is 
never employed. It has been subjected to analysis, and found to con- 
tain a sweetish bitter extract — to which, from these qualities, the name 
Picroglycion, Dulcamarin, or bittersweet principle, has been given, — 
an alkaloid of narcotic properties, termed Solania or Solanina; besides 
other unimportant ingredients. 

Bittersweet has been used in the same class of cases as sarsaparilla, 
mezereum, guaiacum and sassafras; and is probably not possessed of 
more powers than the feeblest of these. Were the author to be guided 
by the results of his own experience, he would say that it is almost 
devoid of action on the economy. He has seen it chewed by boys in 
large quantities; and has chewed it himself when a boy, without 



STILLINGIA. 343 

observing any effect from it, except what was caused by its saccharine 
and gummy matter. The decoction, the extract and the fruit have all 
been given in large quantities, with no more effect; yet solania, which 
has been separated from it, is said to have killed a rabbit in the dose 
of two grains. Certainly, more testimony is needed, before it can be 
regarded as possessed of much efficacy; especially when we are told, 
by Chevallier, that an article, having, according to all, little or no 
narcotic power, occasioned narcotism in a young man, when he merely 
carried a bundle of it on his head ! Dr. Wood of Philadelphia — who 
considers that its use is now nearly confined to the treatment of cuta- 
neous eruptions, particularly those of a scaly character, as lepra, psori- 
asis, and pityriasis, in which he thinks it is often decidedly beneficial, 
especially when combined with minute doses of antimonials, — states, 
that he has observed, in several instances, when the system was under 
its influence, a dark purplish colour of the face and hands ; and, at the 
same time, considerable languor of the circulation. Such effects have 
not been observed by the author, nor are they recorded by others ; but 
whatever rests on the authority of Dr. Wood is deserving of considera- 
tion ; and may lead to farther investigation. Dulcamara is given in the 
form of the officinal decoction ; and is administered in all the cachectic 
conditions that require the employment of the vegetable agents last 
described. The cachexia? in which it is now mainly prescribed, how- 
ever, are those accompanied by chronic diseases of the skin. 

DECOC'TM DULCAMAM, DECOCTION OF BITTERSWEET. (Dulcamar. contus. 
3j ; Aqua Oiss, boiled to a pint.) The dose may be f.^ij to f.^iv three 
or four times a day. 

76. STILLING'IA, QUEEN'S ROOT. 

Stillingia, in the secondary list of the Pharmacopoeia of the United 
States, is the root of Slillingia aquatica, Queers delight; Sex. Syst. 
Moncecia Monadelphia; Nat. Ord. Euphorbiaceae, which grows in 
pine barrens from Virginia to Florida ; flowering in May and June. It 
has been highly extolled by Dr. Thomas Y. Simons, of Charleston; 
who regards it as the best vegetable alterative known ; and believes that 
it will ultimately supersede sarsaparilla, or be esteemed as a most useful 
adjuvant to it. W T ith the views, which the author possesses in regard 
to the eutrophic virtues of sarsaparilla, he cannot consider this to be 
high praise. 

It may be given in powder in the dose of fifteen or twenty grains. 
Or, an ounce of the bruised root may be boiled slowly in a pint and a 
quarter of water to a pint ; and one or two fluidounces of this may be 
given three times a day. A tincture is sometimes made of two ounces 
of the root to a pint of diluted alcohol, the dose of which is a fluidrachm. 
Dr. Frost of Charleston thinks, that the active principle is somewhat 
volatile ; and if such be the case, decoction must be an objectionable 
form of preparation. 



344 SPECIAL EUTROPHICS. 



77. JUGLANS CINER'EA.— WALNUT. 

The leaves of walnut have been highly extolled of late by M. 
Negrier as superior to all other antiscrofulous remedies. He found the 
extract of the leaves, which may be ranked in the class of slightly 
aromatic bitters, to be almost always efficacious in scrofulous affections, 
and in no case did it appear to exert any unpleasant action on the 
economy. Their efficacy is doubtless, however, overrated by him ; 
and their main virtues would appear to be those of the aromatic bitter 
tonics. 

78. MUDAR. 

Under the name Mudar or Madar, a medicine was imported into 
Europe from India, which is the bark of the root of Calotropis gigantea, 
JJsclepias gigantea ; Nat. Ord. Asclepiadaceae, which is a native of 
Hindostan, but has been introduced into the West Indies, where it is 
now naturalized. It appears to have been used in India in the same 
cases as sarsaparilla ; — for example, in syphilitic and syphiloid diseases, 
chronic cutaneous affections, &c. The powdered root — mudar — is 
given in doses of from gr. iij to gr. x, three times a day, gradually 
increased until it induces some degree of nausea and vomiting. It is 
not employed in American practice. 

79. HEMIDES'MUS IN'DICUS.— COUNTRY SARSAPARIL'LA, (OF INDIA). 

This plant, called also Periploca bidica, Asclepias pseudo-sarsa, 
Indian or scented sarsaparilla ; Nat. Ord. Asclepiadaceas, is likewise a 
plant of Hindostan, which has been erroneously referred to Smilax 
aspera. (Pereira.) The root has been employed as a substitute for sar- 
saparilla. It is given in infusion, (Hemidesm. Indie. 5ij ; Aq. bullient.